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	1	0	1	48	5	H0022_001_0	5	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0022	1	0	1	48	5	H0022_001_0	5	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0022	1	0	1	48	5	H0022_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H0028	4	0	1	1	1	H0028_004_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	4	0	1	1	1	H0028_004_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	4	0	1	1	1	H0028_004_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	4	0	1	1	1	H0028_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	4	0	1	1	1	H0028_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	7	0	1	1	1	H0028_007_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	7	0	1	1	1	H0028_007_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	7	0	1	1	1	H0028_007_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	7	0	1	1	1	H0028_007_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	7	0	1	1	1	H0028_007_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	11	0	1	1	1	H0028_011_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	11	0	1	1	1	H0028_011_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	11	0	1	1	1	H0028_011_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	11	0	1	1	1	H0028_011_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											52	50		50				52	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	11	0	1	1	1	H0028_011_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	13	0	1	1	1	H0028_013_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	13	0	1	1	1	H0028_013_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	13	0	1	1	1	H0028_013_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	13	0	1	1	1	H0028_013_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	13	0	1	1	1	H0028_013_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	14	0	1	1	1	H0028_014_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	14	0	1	1	1	H0028_014_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	14	0	1	1	1	H0028_014_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	14	0	1	1	1	H0028_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	14	0	1	1	1	H0028_014_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	15	0	1	1	1	H0028_015_0	7	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	15	0	1	1	1	H0028_015_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	15	0	1	1	1	H0028_015_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	15	0	1	1	1	H0028_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	15	0	1	1	1	H0028_015_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	16	0	1	1	1	H0028_016_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	16	0	1	1	1	H0028_016_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	16	0	1	1	1	H0028_016_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	16	0	1	1	1	H0028_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	16	0	1	1	1	H0028_016_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	17	0	1	1	1	H0028_017_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	17	0	1	1	1	H0028_017_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	17	0	1	1	1	H0028_017_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	17	0	1	1	1	H0028_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	17	0	1	1	1	H0028_017_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	18	0	1	1	1	H0028_018_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	18	0	1	1	1	H0028_018_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	18	0	1	1	1	H0028_018_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	18	0	1	1	1	H0028_018_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	18	0	1	1	1	H0028_018_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	19	0	1	1	1	H0028_019_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	19	0	1	1	1	H0028_019_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	19	0	1	1	1	H0028_019_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	19	0	1	1	1	H0028_019_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	19	0	1	1	1	H0028_019_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	20	0	1	1	1	H0028_020_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	20	0	1	1	1	H0028_020_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	20	0	1	1	1	H0028_020_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	20	0	1	1	1	H0028_020_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	20	0	1	1	1	H0028_020_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	21	0	1	1	1	H0028_021_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	21	0	1	1	1	H0028_021_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	21	0	1	1	1	H0028_021_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	21	0	1	1	1	H0028_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	21	0	1	1	1	H0028_021_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	22	0	1	1	1	H0028_022_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	22	0	1	1	1	H0028_022_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	22	0	1	1	1	H0028_022_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	22	0	1	1	1	H0028_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	22	0	1	1	1	H0028_022_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	23	0	1	1	1	H0028_023_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	23	0	1	1	1	H0028_023_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	23	0	1	1	1	H0028_023_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	23	0	1	1	1	H0028_023_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	23	0	1	1	1	H0028_023_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	24	0	1	1	1	H0028_024_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	24	0	1	1	1	H0028_024_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	24	0	1	1	1	H0028_024_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	24	0	1	1	1	H0028_024_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	24	0	1	1	1	H0028_024_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	1	1	1	1	H0028_025_1	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	1	1	1	1	H0028_025_1	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	1	1	1	1	H0028_025_1	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	1	1	1	1	H0028_025_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	1	1	1	1	H0028_025_1	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	2	1	1	1	H0028_025_2	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	2	1	1	1	H0028_025_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	2	1	1	1	H0028_025_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	2	1	1	1	H0028_025_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	25	2	1	1	1	H0028_025_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	1	1	1	1	H0028_026_1	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	1	1	1	1	H0028_026_1	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	1	1	1	1	H0028_026_1	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	1	1	1	1	H0028_026_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	1	1	1	1	H0028_026_1	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	2	1	1	1	H0028_026_2	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	2	1	1	1	H0028_026_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	2	1	1	1	H0028_026_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	2	1	1	1	H0028_026_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	26	2	1	1	1	H0028_026_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	27	0	1	1	1	H0028_027_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	27	0	1	1	1	H0028_027_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	27	0	1	1	1	H0028_027_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	27	0	1	1	1	H0028_027_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	27	0	1	1	1	H0028_027_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	28	0	1	1	1	H0028_028_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	28	0	1	1	1	H0028_028_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	28	0	1	1	1	H0028_028_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	28	0	1	1	1	H0028_028_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	28	0	1	1	1	H0028_028_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	29	0	1	1	1	H0028_029_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	29	0	1	1	1	H0028_029_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	29	0	1	1	1	H0028_029_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	29	0	1	1	1	H0028_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	29	0	1	1	1	H0028_029_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	30	0	1	1	1	H0028_030_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	30	0	1	1	1	H0028_030_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	30	0	1	1	1	H0028_030_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	30	0	1	1	1	H0028_030_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	30	0	1	1	1	H0028_030_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	31	0	1	1	1	H0028_031_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	31	0	1	1	1	H0028_031_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	31	0	1	1	1	H0028_031_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	31	0	1	1	1	H0028_031_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	31	0	1	1	1	H0028_031_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	32	0	1	1	1	H0028_032_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	32	0	1	1	1	H0028_032_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	32	0	1	1	1	H0028_032_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	32	0	1	1	1	H0028_032_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	32	0	1	1	1	H0028_032_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	33	0	1	1	1	H0028_033_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	33	0	1	1	1	H0028_033_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					18		54											20		60				18		0				20				20			0.67	0.6		0.67	0.6	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	33	0	1	1	1	H0028_033_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	33	0	1	1	1	H0028_033_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	33	0	1	1	1	H0028_033_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	34	0	1	1	1	H0028_034_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	34	0	1	1	1	H0028_034_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	34	0	1	1	1	H0028_034_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	34	0	1	1	1	H0028_034_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	34	0	1	1	1	H0028_034_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	35	0	1	1	1	H0028_035_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	35	0	1	1	1	H0028_035_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					3		9											20		60				3		0				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	35	0	1	1	1	H0028_035_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	35	0	1	1	1	H0028_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	35	0	1	1	1	H0028_035_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	36	0	1	1	1	H0028_036_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	36	0	1	1	1	H0028_036_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	36	0	1	1	1	H0028_036_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	36	0	1	1	1	H0028_036_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	36	0	1	1	1	H0028_036_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	37	0	1	1	1	H0028_037_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	37	0	1	1	1	H0028_037_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	37	0	1	1	1	H0028_037_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	37	0	1	1	1	H0028_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	37	0	1	1	1	H0028_037_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	39	0	1	1	1	H0028_039_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	39	0	1	1	1	H0028_039_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	39	0	1	1	1	H0028_039_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	39	0	1	1	1	H0028_039_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	39	0	1	1	1	H0028_039_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	40	0	1	1	1	H0028_040_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	40	0	1	1	1	H0028_040_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	40	0	1	1	1	H0028_040_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	40	0	1	1	1	H0028_040_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	40	0	1	1	1	H0028_040_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	41	0	1	1	1	H0028_041_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	41	0	1	1	1	H0028_041_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	41	0	1	1	1	H0028_041_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	41	0	1	1	1	H0028_041_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	41	0	1	1	1	H0028_041_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	42	0	1	1	1	H0028_042_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	42	0	1	1	1	H0028_042_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					14		42											20		60				14		0				20				20			0.67	0.47		0.67	0.47	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	42	0	1	1	1	H0028_042_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	42	0	1	1	1	H0028_042_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	42	0	1	1	1	H0028_042_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	1	1	1	1	H0028_043_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	1	1	1	1	H0028_043_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	1	1	1	1	H0028_043_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	1	1	1	1	H0028_043_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	1	1	1	1	H0028_043_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	2	1	1	1	H0028_043_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	2	1	1	1	H0028_043_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	2	1	1	1	H0028_043_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	2	1	1	1	H0028_043_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	43	2	1	1	1	H0028_043_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	44	0	1	1	1	H0028_044_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	44	0	1	1	1	H0028_044_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	44	0	1	1	1	H0028_044_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	44	0	1	1	1	H0028_044_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	44	0	1	1	1	H0028_044_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	45	0	1	1	1	H0028_045_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	45	0	1	1	1	H0028_045_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	45	0	1	1	1	H0028_045_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	45	0	1	1	1	H0028_045_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	45	0	1	1	1	H0028_045_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	46	0	1	1	1	H0028_046_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	46	0	1	1	1	H0028_046_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	46	0	1	1	1	H0028_046_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	46	0	1	1	1	H0028_046_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0028	46	0	1	1	1	H0028_046_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0062	1	0	1	1	1	H0062_001_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	9																			3	6	9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	1	0	1	1	1	H0062_001_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	36																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	1	0	1	1	1	H0062_001_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	1	0	1	1	1	H0062_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	1	0	1	1	1	H0062_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	1	0	1	1	1	H0062_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	2	0	1	1	1	H0062_002_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	2	0	1	1	1	H0062_002_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	14	28	42																			14	28	42																14				14		0.47			0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	2	0	1	1	1	H0062_002_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	2	0	1	1	1	H0062_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	2	0	1	1	1	H0062_002_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	2	0	1	1	1	H0062_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	3	0	1	1	1	H0062_003_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	6																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	3	0	1	1	1	H0062_003_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	36																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	3	0	1	1	1	H0062_003_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	120																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	3	0	1	1	1	H0062_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	3	0	1	1	1	H0062_003_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	3	0	1	1	1	H0062_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	9	0	1	1	1	H0062_009_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	1	2	3																			1	2	2																1				1		0.03			0.03			0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	9	0	1	1	1	H0062_009_0	3	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			5.33	10.67	16																8				8		0.27			0.18			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	9	0	1	1	1	H0062_009_0	3	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	42	84	126																			28	56	84																42				42		1.4			0.93			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	9	0	1	1	1	H0062_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	85	170	255																			56.67	113.33	170																85				85		2.83			1.89			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	9	0	1	1	1	H0062_009_0	3	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0062	9	0	1	1	1	H0062_009_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0088	1	0	1	4	1	H0088_001_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0088	1	0	1	4	1	H0088_001_0	9	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0088	1	0	1	4	1	H0088_001_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0088	1	0	1	4	1	H0088_001_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0088	1	0	1	4	1	H0088_001_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.24	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0088	1	0	1	4	1	H0088_001_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0104	12	0	1	4	1	H0104_012_0	6	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								11		33					4		8					4		8																11				11			0.36	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	12	0	1	4	1	H0104_012_0	6	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		60					13		26					13		26																20				20			0.66	0.43	0.43			0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	12	0	1	4	1	H0104_012_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					40		80					40		80																47				47			1.56	1.33	1.33			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	12	0	1	4	1	H0104_012_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											66	50		50				58	45		45				45		45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	12	0	1	4	1	H0104_012_0	6	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	25		25				1	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	12	0	1	4	1	H0104_012_0	6	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								2		4					2		4					2		4																2				2			0.06	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	12	0	1	4	1	H0104_012_0	6	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								2		6					2		4					2		4																2				2			0.06	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0104	14	0	1	4	1	H0104_014_0	6	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								11		33					4		8					4		8																11				11			0.36	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	14	0	1	4	1	H0104_014_0	6	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		60					13		26					13		26																20				20			0.66	0.43	0.43			0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	14	0	1	4	1	H0104_014_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					40		80					40		80																47				47			1.56	1.33	1.33			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	14	0	1	4	1	H0104_014_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											66	50		50				53	45		45				45		45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	14	0	1	4	1	H0104_014_0	6	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	25		25				1	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	14	0	1	4	1	H0104_014_0	6	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								2		6					2		4					2		4																2				2			0.06	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	14	0	1	4	1	H0104_014_0	6	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								2		6					2		4					2		4																2				2			0.06	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0104	15	0	1	4	1	H0104_015_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		30					3		6					3		6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	15	0	1	4	1	H0104_015_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					8		16					8		16																15				15			0.5	0.26	0.26			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	15	0	1	4	1	H0104_015_0	4	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					40		80					40		80																47				47			1.56	1.33	1.33			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	15	0	1	4	1	H0104_015_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											51	50		50				39	45		45				45		45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	15	0	1	4	1	H0104_015_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	33		33				1	33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	15	0	1	4	1	H0104_015_0	4	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								2		6					2		4					2		4																2				2			0.06	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0104	15	0	1	4	1	H0104_015_0	4	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								2		6					2		4					2		4																2				2			0.06	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0107	3	0	1	4	1	H0107_003_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	3	0	1	4	1	H0107_003_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H0107	3	0	1	4	1	H0107_003_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	3	0	1	4	1	H0107_003_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	3	0	1	4	1	H0107_003_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	3	0	1	4	1	H0107_003_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	4	0	1	4	1	H0107_004_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	4	0	1	4	1	H0107_004_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H0107	4	0	1	4	1	H0107_004_0	4	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	4	0	1	4	1	H0107_004_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	4	0	1	4	1	H0107_004_0	4	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0107	4	0	1	4	1	H0107_004_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0111	1	0	1	4	1	H0111_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	1	0	1	4	1	H0111_001_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H0111	1	0	1	4	1	H0111_001_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	1	0	1	4	1	H0111_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	1	0	1	4	1	H0111_001_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				78.96	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	1	0	1	4	1	H0111_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	2	0	1	4	1	H0111_002_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	2	0	1	4	1	H0111_002_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H0111	2	0	1	4	1	H0111_002_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	2	0	1	4	1	H0111_002_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	2	0	1	4	1	H0111_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				92.1	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	2	0	1	4	1	H0111_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	3	0	1	4	1	H0111_003_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	3	0	1	4	1	H0111_003_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0111	3	0	1	4	1	H0111_003_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	3	0	1	4	1	H0111_003_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	3	0	1	4	1	H0111_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				87.68	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0111	3	0	1	4	1	H0111_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0137	1	0	1	48	5	H0137_001_0	3	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs"	3	0	0	0	0	0	0	0	0			
H0137	1	0	1	48	5	H0137_001_0	3	Preferred Brand Drugs	4	10			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs"	3	0	0	0	0	0	0	0	0			
H0137	1	0	1	48	5	H0137_001_0	3	Non-Preferred Brand Drugs	4	10			3	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs"	3	0	0	0	0	0	0	0	0			
H0148	1	0	1	48	5	H0148_001_0	4	Preferred Generic Drugs	4	1			1	1	111		10	100		1	30	60	90				2	2			90					10	31																																														0						0	"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0148	1	0	1	48	5	H0148_001_0	4	Generic Drugs	4	1			2	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6					0	3.6			
H0148	1	0	1	48	5	H0148_001_0	4	Brand Drugs	4	10			3	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95					0	8.95			
H0148	1	0	1	48	5	H0148_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			4	1	10		10			1	30															10	31																																														0						0	"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0			0	0			
H0148	2	0	1	48	5	H0148_002_0	4	Preferred Generic Drugs	4	1			1	1	111		10	100		1	30	60	90				2	2			90					10	31																																														0						0	"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0148	2	0	1	48	5	H0148_002_0	4	Generic Drugs	4	1			2	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6					0	3.6			
H0148	2	0	1	48	5	H0148_002_0	4	Brand Drugs	4	10			3	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95					0	8.95			
H0148	2	0	1	48	5	H0148_002_0	4	Non-Medicare Rx/OTC Drugs	4	11			4	1	10		10			1	30															10	31																																														0						0	"Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0			0	0			
H0154	11	0	1	1	1	H0154_011_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								4	8	12					0	0	0											4	8	12				0	0	0				4				4			0.13	0		0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	11	0	1	1	1	H0154_011_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					8	16	24											8	16	24				7	13.5	16				8				8			0.27	0.27		0.27	0.23	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	11	0	1	1	1	H0154_011_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					47	94	141											47	94	141				39.5	78.5	94				47				47			1.57	1.57		1.57	1.32	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	11	0	1	1	1	H0154_011_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											57.78	50	50	50				57.78	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	11	0	1	1	1	H0154_011_0	4	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											1	33						1	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	12	0	1	1	1	H0154_012_0	5	Preferred Generic	3	11	1	1	1	1	111		1	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	12	0	1	1	1	H0154_012_0	5	Generic	3	11	1	1	2	1	111		1	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	12	0	1	1	1	H0154_012_0	5	Preferred Brand	3	11	1	1	3	1	111		1	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	12	0	1	1	1	H0154_012_0	5	Non-Preferred Drug	3	11	1	1	4	1	111		1	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	12	0	1	1	1	H0154_012_0	5	Specialty Tier	3	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	14	0	1	1	1	H0154_014_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								4	8	12					0	0	0											4	8	12				0	0	0				4				4			0.13	0		0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	14	0	1	1	1	H0154_014_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					12	24	36											12	24	36				10	20	24				12				12			0.4	0.4		0.4	0.33	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	14	0	1	1	1	H0154_014_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					47	94	141											47	94	141				39.5	78.5	94				47				47			1.57	1.57		1.57	1.32	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	14	0	1	1	1	H0154_014_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											61.28	50	50	50				61.28	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	14	0	1	1	1	H0154_014_0	4	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											1	33						1	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	1	1	1	1	H0154_015_1	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								4	8	12					0	0	0											4	8	12				0	0	0				4				4			0.13	0		0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	1	1	1	1	H0154_015_1	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					14	28	42											14	28	42				12	24	28				14				14			0.47	0.47		0.47	0.4	0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	1	1	1	1	H0154_015_1	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					47	94	141											47	94	141				39.5	78.5	94				47				47			1.57	1.57		1.57	1.32	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	1	1	1	1	H0154_015_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											96.47	45	45	45				96.47	45	45	45										45	45	45				45	45	45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	1	1	1	1	H0154_015_1	4	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											1	30						1	30																							30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	2	1	1	1	H0154_015_2	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								4	8	12					0	0	0											4	8	12				0	0	0				4				4			0.13	0		0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	2	1	1	1	H0154_015_2	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					14	28	42											14	28	42				12	24	28				14				14			0.47	0.47		0.47	0.4	0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	2	1	1	1	H0154_015_2	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					47	94	141											47	94	141				39.5	78.5	94				47				47			1.57	1.57		1.57	1.32	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	2	1	1	1	H0154_015_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											96.47	45	45	45				96.47	45	45	45										45	45	45				45	45	45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	15	2	1	1	1	H0154_015_2	4	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											1	30						1	30																							30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	16	0	1	1	1	H0154_016_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								4	8	12					0	0	0											4	8	12				0	0	0				4				4			0.13	0		0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	16	0	1	1	1	H0154_016_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					12	24	36											12	24	36				10	20	24				12				12			0.4	0.4		0.4	0.33	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	16	0	1	1	1	H0154_016_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					47	94	141											47	94	141				39.5	78.5	94				47				47			1.57	1.57		1.57	1.32	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	16	0	1	1	1	H0154_016_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											59.71	50	50	50				59.71	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0154	16	0	1	1	1	H0154_016_0	4	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											1	33						1	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	1	0	1	1	1	H0174_001_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		5																									2		5				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	1	0	1	1	1	H0174_001_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		20																									8		20				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	1	0	1	1	1	H0174_001_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		117.5																									47		117.5				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	1	0	1	1	1	H0174_001_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.21	49		49																								49		49				49		49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	1	0	1	1	1	H0174_001_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	2	0	1	1	1	H0174_002_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	2	0	1	1	1	H0174_002_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		12.5																									5		12.5				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	2	0	1	1	1	H0174_002_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		87.5																									35		87.5				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	2	0	1	1	1	H0174_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		250																									100		250				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	2	0	1	1	1	H0174_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	3	0	1	1	1	H0174_003_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	3	0	1	1	1	H0174_003_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0174	3	0	1	1	1	H0174_003_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		20																									8		20				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	3	0	1	1	1	H0174_003_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		87.5																									35		87.5				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	3	0	1	1	1	H0174_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		225																									90		225				90		180				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	3	0	1	1	1	H0174_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					28																										28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	4	0	1	1	1	H0174_004_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		2.5																									1		2.5				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	4	0	1	1	1	H0174_004_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	14		35																									14		35				14		0				14				14		0.47				0.47	0.47	0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	4	0	1	1	1	H0174_004_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		117.5																									47		117.5				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	4	0	1	1	1	H0174_004_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.36	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	4	0	1	1	1	H0174_004_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	5	0	1	2	1	H0174_005_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	5	0	1	2	1	H0174_005_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0174	5	0	1	2	1	H0174_005_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		12.5																									5		12.5				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	5	0	1	2	1	H0174_005_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	30		75																									30		75				30		60				30				30		1				1	1	0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	5	0	1	2	1	H0174_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				81.08	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	5	0	1	2	1	H0174_005_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	6	0	1	1	1	H0174_006_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		2.5																									1		2.5				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	6	0	1	1	1	H0174_006_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	16		40																									16		40				16		0				16				16		0.53				0.53	0.53	0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	6	0	1	1	1	H0174_006_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		117.5																									47		117.5				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	6	0	1	1	1	H0174_006_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				83.67	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	6	0	1	1	1	H0174_006_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	7	0	1	1	1	H0174_007_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	7	0	1	1	1	H0174_007_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		17.5																									7		17.5				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	7	0	1	1	1	H0174_007_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	30		75																									30		75				30		60				30				30		1				1	1	0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	7	0	1	1	1	H0174_007_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.41	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	7	0	1	1	1	H0174_007_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					27																										27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	8	0	1	1	1	H0174_008_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	8	0	1	1	1	H0174_008_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0174	8	0	1	1	1	H0174_008_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		12.5																									5		12.5				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	8	0	1	1	1	H0174_008_0	4	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	5		12.5																									5		12.5				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0174	8	0	1	1	1	H0174_008_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		25																									10		25				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	8	0	1	1	1	H0174_008_0	4	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		25																									10		25				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H0174	8	0	1	1	1	H0174_008_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.77	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0174	8	0	1	1	1	H0174_008_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0192	1	0	1	48	5	H0192_001_0	1	Generic Drugs	4	1			1	1	111		1	100		1	30	60	90				1	2			90				30		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0192	1	0	1	48	5	H0192_001_0	1	Brand Drugs	4	10			2	1	111		1	100		1	30	60	90				1	2			90				30		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0192	1	0	1	48	5	H0192_001_0	1	Non-Medicare Rx/OTC Drugs	4	10			3	1	111		1	100		1	30	60	90				1	2			90				30		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H0270	1	0	1	4	1	H0270_001_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0270	1	0	1	4	1	H0270_001_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0270	1	0	1	4	1	H0270_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0270	1	0	1	4	1	H0270_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0270	1	0	1	4	1	H0270_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					30																										30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0281	1	0	1	48	5	H0281_001_0	3	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0281	1	0	1	48	5	H0281_001_0	3	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0281	1	0	1	48	5	H0281_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H0292	1	0	1	1	1	H0292_001_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	1	0	1	1	1	H0292_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	1	0	1	1	1	H0292_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	1	0	1	1	1	H0292_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	1	0	1	1	1	H0292_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	2	0	1	1	1	H0292_002_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	2	0	1	1	1	H0292_002_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	2	0	1	1	1	H0292_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	2	0	1	1	1	H0292_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0292	2	0	1	1	1	H0292_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	2	0	1	4	1	H0294_002_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	2	0	1	4	1	H0294_002_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	2	0	1	4	1	H0294_002_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	2	0	1	4	1	H0294_002_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	2	0	1	4	1	H0294_002_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				916	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	4	0	1	4	1	H0294_004_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	4	0	1	4	1	H0294_004_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	4	0	1	4	1	H0294_004_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	4	0	1	4	1	H0294_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	4	0	1	4	1	H0294_004_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				869	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	10	0	1	4	1	H0294_010_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	10	0	1	4	1	H0294_010_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	10	0	1	4	1	H0294_010_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	10	0	1	4	1	H0294_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	10	0	1	4	1	H0294_010_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				676	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	11	0	1	4	1	H0294_011_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	11	0	1	4	1	H0294_011_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	11	0	1	4	1	H0294_011_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	11	0	1	4	1	H0294_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	11	0	1	4	1	H0294_011_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				881	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	12	0	1	4	1	H0294_012_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	12	0	1	4	1	H0294_012_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	12	0	1	4	1	H0294_012_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	12	0	1	4	1	H0294_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	12	0	1	4	1	H0294_012_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1645	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	15	0	1	4	1	H0294_015_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	15	0	1	4	1	H0294_015_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	15	0	1	4	1	H0294_015_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	15	0	1	4	1	H0294_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	15	0	1	4	1	H0294_015_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1014	28		28				764	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	16	0	1	4	1	H0294_016_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	16	0	1	4	1	H0294_016_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	16	0	1	4	1	H0294_016_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	16	0	1	4	1	H0294_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0294	16	0	1	4	1	H0294_016_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1016	27		27				830	27		27												27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0302	1	0	1	1	1	H0302_001_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		3																					3																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	1	0	1	1	1	H0302_001_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	9		9																					9																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	1	0	1	1	1	H0302_001_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					120																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	1	0	1	1	1	H0302_001_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					270																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	1	0	1	1	1	H0302_001_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	6	0	1	1	1	H0302_006_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		3																					3																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	6	0	1	1	1	H0302_006_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	9		9																					9																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	6	0	1	1	1	H0302_006_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	6	0	1	1	1	H0302_006_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	6	0	1	1	1	H0302_006_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	8	0	1	1	1	H0302_008_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		3																					3																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	8	0	1	1	1	H0302_008_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	9		9																					9																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	8	0	1	1	1	H0302_008_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	8	0	1	1	1	H0302_008_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	8	0	1	1	1	H0302_008_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	9	0	1	1	1	H0302_009_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		3																					3																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	9	0	1	1	1	H0302_009_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	9		9																					9																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	9	0	1	1	1	H0302_009_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	9	0	1	1	1	H0302_009_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0302	9	0	1	1	1	H0302_009_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					30																																					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	2	0	1	1	1	H0332_002_0	10	Preferred Generic	4	1	1	2	1	1		110	1			1				30		90	1	2							30		31								8		24					3		7.5																							8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	2	0	1	1	1	H0332_002_0	10	Preferred Generic	4	1	1	2	1	3		110	1			1				30		90	1	2							30		31								8		24					3		7.5																							8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H0332	2	0	1	1	1	H0332_002_0	10	Generic	4	1	1	2	2	1		110	1			1				30		90	1	2							30		31								10		30					5		12.5																							10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	2	0	1	1	1	H0332_002_0	10	Preferred Brand	4	10	1	2	3	1		110	1			1				30		90	1	2							30		31								45		135					40		100																							45				45			1.5	1.33				1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	2	0	1	1	1	H0332_002_0	10	Non-Preferred Brand	4	10	1	2	4	1		110	1			1				30		90	1	2							30		31								70		210					60		150																							70				70			2.33	2				2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	2	0	1	1	1	H0332_002_0	10	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31												31							31																							31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	4	0	1	2	1	H0332_004_0	10	Preferred Generic	4	1	1	2	1	1		110	1			1				30		90	1	2							30		31								8		24					3		7.5																							8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	4	0	1	2	1	H0332_004_0	10	Preferred Generic	4	1	1	2	1	3		110	1			1				30		90	1	2							30		31								8		24					3		7.5																							8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H0332	4	0	1	2	1	H0332_004_0	10	Generic	4	1	1	2	2	1		110	1			1				30		90	1	2							30		31								10		30					5		12.5																							10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	4	0	1	2	1	H0332_004_0	10	Preferred Brand	4	10	1	2	3	1		110	1			1				30		90	1	2							30		31								45		135					40		100																							45				45			1.5	1.33				1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	4	0	1	2	1	H0332_004_0	10	Non-Preferred Brand	4	10	1	2	4	1		110	1			1				30		90	1	2							30		31								70		210					60		150																							70				70			2.33	2				2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	4	0	1	2	1	H0332_004_0	10	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31												31							31																							31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	8	0	1	2	1	H0332_008_0	10	Preferred Generic	4	1	1	2	1	1		110	1			1				30		90	1	2							30		31								8		24					3		7.5																							8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	8	0	1	2	1	H0332_008_0	10	Preferred Generic	4	1	1	2	1	3		110	1			1				30		90	1	2							30		31								8		24					3		7.5																							8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H0332	8	0	1	2	1	H0332_008_0	10	Generic	4	1	1	2	2	1		110	1			1				30		90	1	2							30		31								10		30					5		12.5																							10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	8	0	1	2	1	H0332_008_0	10	Preferred Brand	4	10	1	2	3	1		110	1			1				30		90	1	2							30		31								45		135					40		100																							45				45			1.5	1.33				1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	8	0	1	2	1	H0332_008_0	10	Non-Preferred Brand	4	10	1	2	4	1		110	1			1				30		90	1	2							30		31								70		210					60		150																							70				70			2.33	2				2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0332	8	0	1	2	1	H0332_008_0	10	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31												31							31																							31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0336	1	0	1	48	5	H0336_001_0	2	Generic Drugs	4	1			1	1	110		1	110		1	30		90				2	2	30		90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0336	1	0	1	48	5	H0336_001_0	2	Brand Drugs	4	10			2	1	110		1	110		1	30		90				2	2	30		90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0336	1	0	1	48	5	H0336_001_0	2	Non-Medicare Rx Drugs	4	11			3	1	110		1	110		1	30		90				1	2	30		90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H0336	1	0	1	48	5	H0336_001_0	2	Non-Medicare OTC Drugs	4	11			4	1	110		1	110		1	30		90				1	2	30		90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H0351	38	0	1	1	1	H0351_038_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	12																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	38	0	1	1	1	H0351_038_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	42																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	38	0	1	1	1	H0351_038_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	38	0	1	1	1	H0351_038_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	38	0	1	1	1	H0351_038_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	38	0	1	1	1	H0351_038_0	6	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	1	1	1	1	H0351_044_1	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	7																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	1	1	1	1	H0351_044_1	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	42																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	1	1	1	1	H0351_044_1	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	1	1	1	1	H0351_044_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	1	1	1	1	H0351_044_1	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	1	1	1	1	H0351_044_1	6	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	2	1	1	1	H0351_044_2	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	7																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	2	1	1	1	H0351_044_2	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	42																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	2	1	1	1	H0351_044_2	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	2	1	1	1	H0351_044_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	2	1	1	1	H0351_044_2	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	44	2	1	1	1	H0351_044_2	6	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	50	0	1	1	1	H0351_050_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	12																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	50	0	1	1	1	H0351_050_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	42																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	50	0	1	1	1	H0351_050_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	50	0	1	1	1	H0351_050_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	50	0	1	1	1	H0351_050_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	50	0	1	1	1	H0351_050_0	6	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	51	0	1	1	1	H0351_051_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	51	0	1	1	1	H0351_051_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	42																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	51	0	1	1	1	H0351_051_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	51	0	1	1	1	H0351_051_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	51	0	1	1	1	H0351_051_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0351	51	0	1	1	1	H0351_051_0	6	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0354	1	0	1	1	1	H0354_001_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	1	0	1	1	1	H0354_001_0	5	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0354	1	0	1	1	1	H0354_001_0	5	Generic	4	1	3	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	1	0	1	1	1	H0354_001_0	5	Generic	4	1	3	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0354	1	0	1	1	1	H0354_001_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	1	0	1	1	1	H0354_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	1	0	1	1	1	H0354_001_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1071.77	33						797.36	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	24	0	1	1	1	H0354_024_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	24	0	1	1	1	H0354_024_0	5	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0354	24	0	1	1	1	H0354_024_0	5	Generic	4	1	3	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	24	0	1	1	1	H0354_024_0	5	Generic	4	1	3	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0354	24	0	1	1	1	H0354_024_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	24	0	1	1	1	H0354_024_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	24	0	1	1	1	H0354_024_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1001.76	33						897.94	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	27	0	1	1	1	H0354_027_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0354	27	0	1	1	1	H0354_027_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H0354	27	0	1	1	1	H0354_027_0	4	Generic	4	1	3	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0354	27	0	1	1	1	H0354_027_0	4	Generic	4	1	3	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H0354	27	0	1	1	1	H0354_027_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0354	27	0	1	1	1	H0354_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0354	27	0	1	1	1	H0354_027_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											988.19	33						704.59	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0354	27	0	1	1	1	H0354_027_0	4	Select Diabetic Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					9	18	18											11	22	33				9	18	18				11				11			0.37	0.3		0.37	0.3	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0354	28	0	1	1	1	H0354_028_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	28	0	1	1	1	H0354_028_0	5	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0354	28	0	1	1	1	H0354_028_0	5	Generic	4	1	3	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	28	0	1	1	1	H0354_028_0	5	Generic	4	1	3	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					0	0	0											13	26	39				0	0	0				13				13			0.43	0		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0354	28	0	1	1	1	H0354_028_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	28	0	1	1	1	H0354_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0354	28	0	1	1	1	H0354_028_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1071.98	33						810.7	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	1	0	1	2	1	H0422_001_0	5	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					3		9											12		24				3		6					12			12			0.4	0.1		0.4	0.1	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	1	0	1	2	1	H0422_001_0	5	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					15		45											20		40				15		30					20			20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	1	0	1	2	1	H0422_001_0	5	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47		141					47		141											47		94				47		94					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	1	0	1	2	1	H0422_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											46	50		50				42	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	1	0	1	2	1	H0422_001_0	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1376	25		25				1376	25		25										25		25				25		25				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	2	0	1	2	1	H0422_002_0	6	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					3		9											12		24				3		6					12			12			0.4	0.1		0.4	0.1	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	2	0	1	2	1	H0422_002_0	6	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					15		45											20		40				15		30					20			20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	2	0	1	2	1	H0422_002_0	6	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47		141					42		126											47		94				42		84					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	2	0	1	2	1	H0422_002_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											47	50		50				42	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0422	2	0	1	2	1	H0422_002_0	6	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2070	33		33				2070	33		33										33		33				33		33				33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	1	0	1	1	1	H0432_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	1	0	1	1	1	H0432_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	1	0	1	1	1	H0432_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	1	0	1	1	1	H0432_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	1	0	1	1	1	H0432_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				824	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	2	0	1	1	1	H0432_002_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	2	0	1	1	1	H0432_002_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	2	0	1	1	1	H0432_002_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	2	0	1	1	1	H0432_002_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	2	0	1	1	1	H0432_002_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1085	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	3	0	1	1	1	H0432_003_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	3	0	1	1	1	H0432_003_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	3	0	1	1	1	H0432_003_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	3	0	1	1	1	H0432_003_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	3	0	1	1	1	H0432_003_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				850	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	4	0	1	1	1	H0432_004_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	4	0	1	1	1	H0432_004_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	4	0	1	1	1	H0432_004_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	4	0	1	1	1	H0432_004_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	4	0	1	1	1	H0432_004_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1044	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	5	0	1	1	1	H0432_005_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	5	0	1	1	1	H0432_005_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	5	0	1	1	1	H0432_005_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	5	0	1	1	1	H0432_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	5	0	1	1	1	H0432_005_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1008	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	6	0	1	1	1	H0432_006_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	6	0	1	1	1	H0432_006_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	6	0	1	1	1	H0432_006_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	6	0	1	1	1	H0432_006_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	6	0	1	1	1	H0432_006_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				997	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	7	0	1	1	1	H0432_007_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	7	0	1	1	1	H0432_007_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	7	0	1	1	1	H0432_007_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	7	0	1	1	1	H0432_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	7	0	1	1	1	H0432_007_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				858	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	8	0	1	1	1	H0432_008_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	8	0	1	1	1	H0432_008_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	8	0	1	1	1	H0432_008_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	8	0	1	1	1	H0432_008_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	8	0	1	1	1	H0432_008_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1056	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	10	0	1	1	1	H0432_010_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	10	0	1	1	1	H0432_010_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								18		54					3		6													54						6				18				18			0.6	0.1				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	10	0	1	1	1	H0432_010_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	10	0	1	1	1	H0432_010_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	10	0	1	1	1	H0432_010_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											940	32		32				785	32		32												32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	11	0	1	1	1	H0432_011_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	11	0	1	1	1	H0432_011_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								18		54					3		6													54						6				18				18			0.6	0.1				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	11	0	1	1	1	H0432_011_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	11	0	1	1	1	H0432_011_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0432	11	0	1	1	1	H0432_011_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1038	33		33				930	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	1	1	1	1	H0439_003_1	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	1	1	1	1	H0439_003_1	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	1	1	1	1	H0439_003_1	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	1	1	1	1	H0439_003_1	5	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.8	50	50	50				66.49	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	1	1	1	1	H0439_003_1	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											698.52	27						737.97	27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	2	1	1	1	H0439_003_2	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	2	1	1	1	H0439_003_2	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	2	1	1	1	H0439_003_2	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	2	1	1	1	H0439_003_2	5	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.8	50	50	50				66.49	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	3	2	1	1	1	H0439_003_2	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											698.52	27						737.97	27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	6	0	1	2	1	H0439_006_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	6	0	1	2	1	H0439_006_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	6	0	1	2	1	H0439_006_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	6	0	1	2	1	H0439_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	6	0	1	2	1	H0439_006_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											877.52	33						952.55	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	7	0	1	1	1	H0439_007_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	6											8	16	24				3	6	0				8				8			0.27	0.1		0.27	0.1	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	7	0	1	1	1	H0439_007_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								17	34	51					12	24	24											17	34	51				12	24	0				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	7	0	1	1	1	H0439_007_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	7	0	1	1	1	H0439_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	7	0	1	1	1	H0439_007_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											883.74	33						894.95	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	8	0	1	1	1	H0439_008_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	6											8	16	24				3	6	0				8				8			0.27	0.1		0.27	0.1	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	8	0	1	1	1	H0439_008_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								17	34	51					12	24	24											17	34	51				12	24	0				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	8	0	1	1	1	H0439_008_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	8	0	1	1	1	H0439_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	8	0	1	1	1	H0439_008_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											892.13	31						921.3	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	9	0	1	1	1	H0439_009_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	6											8	16	24				3	6	0				8				8			0.27	0.1		0.27	0.1	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	9	0	1	1	1	H0439_009_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								17	34	51					12	24	24											17	34	51				12	24	0				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	9	0	1	1	1	H0439_009_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	9	0	1	1	1	H0439_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	9	0	1	1	1	H0439_009_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											962.1	33						970.57	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	10	0	1	1	1	H0439_010_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	4											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	10	0	1	1	1	H0439_010_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	10	0	1	1	1	H0439_010_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	10	0	1	1	1	H0439_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	10	0	1	1	1	H0439_010_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											953.57	31						896.96	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	11	0	1	1	1	H0439_011_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	6											8	16	24				3	6	0				8				8			0.27	0.1		0.27	0.1	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	11	0	1	1	1	H0439_011_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								17	34	51					12	24	24											17	34	51				12	24	0				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	11	0	1	1	1	H0439_011_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	11	0	1	1	1	H0439_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0439	11	0	1	1	1	H0439_011_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1040.12	33						978.14	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	1	0	1	4	1	H0473_001_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	1	0	1	4	1	H0473_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	1	0	1	4	1	H0473_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	1	0	1	4	1	H0473_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	1	0	1	4	1	H0473_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	3	0	1	4	1	H0473_003_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	3	0	1	4	1	H0473_003_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	3	0	1	4	1	H0473_003_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	3	0	1	4	1	H0473_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0473	3	0	1	4	1	H0473_003_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0480	1	0	1	48	5	H0480_001_0	8	Generic Drugs	4	1			1	1	110		1	100		1	30		90				2	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0480	1	0	1	48	5	H0480_001_0	8	Brand Drugs	4	10			2	1	110		1	100		1	30		90				2	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0480	1	0	1	48	5	H0480_001_0	8	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		1	100		1	30		90				1	1			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H0504	15	0	1	1	1	H0504_015_0	8	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	15	0	1	1	1	H0504_015_0	8	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	15	0	1	1	1	H0504_015_0	8	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								12	24	36					5	10	7.5							7.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	15	0	1	1	1	H0504_015_0	8	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								12	24	36					5	10	7.5							7.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	15	0	1	1	1	H0504_015_0	8	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					38	76	95							95																47				47			1.57	1.27				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	15	0	1	1	1	H0504_015_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	15	0	1	1	1	H0504_015_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	15	0	1	1	1	H0504_015_0	8	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	15	0	1	1	1	H0504_015_0	8	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	17	0	1	1	1	H0504_017_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	17	0	1	1	1	H0504_017_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	17	0	1	1	1	H0504_017_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								18	36	54					10	20	15							15																18				18			0.6	0.33				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	17	0	1	1	1	H0504_017_0	7	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								18	36	54					10	20	15							15																18				18			0.6	0.33				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	17	0	1	1	1	H0504_017_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	17	0	1	1	1	H0504_017_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	17	0	1	1	1	H0504_017_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	17	0	1	1	1	H0504_017_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	17	0	1	1	1	H0504_017_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	21	0	1	1	1	H0504_021_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	21	0	1	1	1	H0504_021_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	21	0	1	1	1	H0504_021_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								18	36	54					10	20	15							15																18				18			0.6	0.33				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	21	0	1	1	1	H0504_021_0	7	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								18	36	54					10	20	15							15																18				18			0.6	0.33				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	21	0	1	1	1	H0504_021_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	21	0	1	1	1	H0504_021_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	21	0	1	1	1	H0504_021_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	21	0	1	1	1	H0504_021_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	21	0	1	1	1	H0504_021_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	26	0	1	1	1	H0504_026_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	26	0	1	1	1	H0504_026_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	26	0	1	1	1	H0504_026_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								18	36	54					10	20	15							15																18				18			0.6	0.33				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	26	0	1	1	1	H0504_026_0	7	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								18	36	54					10	20	15							15																18				18			0.6	0.33				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	26	0	1	1	1	H0504_026_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	26	0	1	1	1	H0504_026_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	26	0	1	1	1	H0504_026_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	26	0	1	1	1	H0504_026_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	26	0	1	1	1	H0504_026_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	28	0	1	1	1	H0504_028_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	28	0	1	1	1	H0504_028_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	28	0	1	1	1	H0504_028_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								12	24	36					5	10	7.5							7.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	28	0	1	1	1	H0504_028_0	7	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								12	24	36					5	10	7.5							7.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	28	0	1	1	1	H0504_028_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	28	0	1	1	1	H0504_028_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	28	0	1	1	1	H0504_028_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	28	0	1	1	1	H0504_028_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	28	0	1	1	1	H0504_028_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	29	0	1	1	1	H0504_029_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	29	0	1	1	1	H0504_029_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	29	0	1	1	1	H0504_029_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								18	36	54					10	20	15							15																18				18			0.6	0.33				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	29	0	1	1	1	H0504_029_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	29	0	1	1	1	H0504_029_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	29	0	1	1	1	H0504_029_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	29	0	1	1	1	H0504_029_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	29	0	1	1	1	H0504_029_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	31	0	1	1	1	H0504_031_0	8	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	31	0	1	1	1	H0504_031_0	8	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	31	0	1	1	1	H0504_031_0	8	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								20	40	60					12	24	18							18																20				20			0.67	0.4				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	31	0	1	1	1	H0504_031_0	8	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	31	0	1	1	1	H0504_031_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	31	0	1	1	1	H0504_031_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	31	0	1	1	1	H0504_031_0	8	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	31	0	1	1	1	H0504_031_0	8	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	37	0	1	1	1	H0504_037_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	37	0	1	1	1	H0504_037_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	37	0	1	1	1	H0504_037_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								20	40	60					12	24	18							18																20				20			0.67	0.4				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	37	0	1	1	1	H0504_037_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	37	0	1	1	1	H0504_037_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	37	0	1	1	1	H0504_037_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	37	0	1	1	1	H0504_037_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	37	0	1	1	1	H0504_037_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	38	0	1	1	1	H0504_038_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	38	0	1	1	1	H0504_038_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	38	0	1	1	1	H0504_038_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								20	40	60					15	30	22.5							22.5																20				20			0.67	0.5				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	38	0	1	1	1	H0504_038_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	38	0	1	1	1	H0504_038_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	38	0	1	1	1	H0504_038_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	38	0	1	1	1	H0504_038_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	38	0	1	1	1	H0504_038_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	39	0	1	1	1	H0504_039_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	39	0	1	1	1	H0504_039_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	39	0	1	1	1	H0504_039_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								15	30	45					10	20	15							15																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	39	0	1	1	1	H0504_039_0	7	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								15	30	45					10	20	15							15																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	39	0	1	1	1	H0504_039_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	39	0	1	1	1	H0504_039_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	39	0	1	1	1	H0504_039_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	39	0	1	1	1	H0504_039_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	39	0	1	1	1	H0504_039_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	40	0	1	1	1	H0504_040_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	40	0	1	1	1	H0504_040_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	40	0	1	1	1	H0504_040_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								12	24	36					5	10	7.5							7.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	40	0	1	1	1	H0504_040_0	7	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								12	24	36					5	10	7.5							7.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	40	0	1	1	1	H0504_040_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					35	70	87.5							87.5																47				47			1.57	1.17				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	40	0	1	1	1	H0504_040_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					90	180	225							225																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	40	0	1	1	1	H0504_040_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	40	0	1	1	1	H0504_040_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	40	0	1	1	1	H0504_040_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	41	0	1	1	1	H0504_041_0	6	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	41	0	1	1	1	H0504_041_0	6	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	41	0	1	1	1	H0504_041_0	6	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								20	40	60					12	24	18							18																20				20			0.67	0.4				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	41	0	1	1	1	H0504_041_0	6	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	41	0	1	1	1	H0504_041_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	41	0	1	1	1	H0504_041_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	41	0	1	1	1	H0504_041_0	6	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	41	0	1	1	1	H0504_041_0	6	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	42	0	1	1	1	H0504_042_0	6	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	42	0	1	1	1	H0504_042_0	6	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	42	0	1	1	1	H0504_042_0	6	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								20	40	60					12	24	18							18																20				20			0.67	0.4				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	42	0	1	1	1	H0504_042_0	6	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	42	0	1	1	1	H0504_042_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	42	0	1	1	1	H0504_042_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											931.04	31						931.04	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	42	0	1	1	1	H0504_042_0	6	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	42	0	1	1	1	H0504_042_0	6	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	43	0	1	1	1	H0504_043_0	8	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	43	0	1	1	1	H0504_043_0	8	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	43	0	1	1	1	H0504_043_0	8	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								10	20	30					3	6	4.5							4.5																10				10			0.33	0.1				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	43	0	1	1	1	H0504_043_0	8	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								10	20	30					3	6	4.5							4.5																10				10			0.33	0.1				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	43	0	1	1	1	H0504_043_0	8	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					35	70	87.5							87.5																47				47			1.57	1.17				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	43	0	1	1	1	H0504_043_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					90	180	225							225																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	43	0	1	1	1	H0504_043_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	43	0	1	1	1	H0504_043_0	8	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	43	0	1	1	1	H0504_043_0	8	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	44	0	1	1	1	H0504_044_0	8	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	44	0	1	1	1	H0504_044_0	8	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	44	0	1	1	1	H0504_044_0	8	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								17	34	51					10	20	15							15																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	44	0	1	1	1	H0504_044_0	8	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	44	0	1	1	1	H0504_044_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	44	0	1	1	1	H0504_044_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	44	0	1	1	1	H0504_044_0	8	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	44	0	1	1	1	H0504_044_0	8	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	45	0	1	1	1	H0504_045_0	7	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	45	0	1	1	1	H0504_045_0	7	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0504	45	0	1	1	1	H0504_045_0	7	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								17	34	51					10	20	15							15																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	45	0	1	1	1	H0504_045_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	45	0	1	1	1	H0504_045_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	45	0	1	1	1	H0504_045_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	45	0	1	1	1	H0504_045_0	7	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0504	45	0	1	1	1	H0504_045_0	7	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0523	2	0	1	1	1	H0523_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	2	0	1	1	1	H0523_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	2	0	1	1	1	H0523_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	2	0	1	1	1	H0523_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	2	0	1	1	1	H0523_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	2	0	1	1	1	H0523_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	2	0	1	1	1	H0523_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											624.39	33						549.29	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	22	0	1	1	1	H0523_022_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	22	0	1	1	1	H0523_022_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	22	0	1	1	1	H0523_022_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	22	0	1	1	1	H0523_022_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	22	0	1	1	1	H0523_022_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	22	0	1	1	1	H0523_022_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	22	0	1	1	1	H0523_022_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											868.08	33						865.2	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	31	0	1	1	1	H0523_031_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	31	0	1	1	1	H0523_031_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	31	0	1	1	1	H0523_031_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	31	0	1	1	1	H0523_031_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	31	0	1	1	1	H0523_031_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	31	0	1	1	1	H0523_031_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	31	0	1	1	1	H0523_031_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											828.63	33						773.04	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	52	0	1	1	1	H0523_052_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	52	0	1	1	1	H0523_052_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	52	0	1	1	1	H0523_052_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	52	0	1	1	1	H0523_052_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	52	0	1	1	1	H0523_052_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	52	0	1	1	1	H0523_052_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	52	0	1	1	1	H0523_052_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											663.67	33						629.62	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	61	0	1	1	1	H0523_061_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	61	0	1	1	1	H0523_061_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	61	0	1	1	1	H0523_061_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	61	0	1	1	1	H0523_061_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	61	0	1	1	1	H0523_061_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	61	0	1	1	1	H0523_061_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	61	0	1	1	1	H0523_061_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.19	33						635.34	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	63	0	1	1	1	H0523_063_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	63	0	1	1	1	H0523_063_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	63	0	1	1	1	H0523_063_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	63	0	1	1	1	H0523_063_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0523	63	0	1	1	1	H0523_063_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	63	0	1	1	1	H0523_063_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0523	63	0	1	1	1	H0523_063_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											757.21	33						724.97	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0524	2	0	2	1	1	H0524_002_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	2	0	2	1	1	H0524_002_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	2	0	2	1	1	H0524_002_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	2	0	2	1	1	H0524_002_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	2	0	2	1	1	H0524_002_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	2	0	2	1	1	H0524_002_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	2	0	2	1	1	H0524_002_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				2191	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	2	0	2	1	1	H0524_002_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	2	0	2	1	1	H0524_002_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	3	0	1	1	1	H0524_003_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	3	0	1	1	1	H0524_003_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	3	0	1	1	1	H0524_003_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	3	0	1	1	1	H0524_003_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	3	0	1	1	1	H0524_003_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	3	0	1	1	1	H0524_003_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	3	0	1	1	1	H0524_003_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1597	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	3	0	1	1	1	H0524_003_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	3	0	1	1	1	H0524_003_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	8	0	1	1	1	H0524_008_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	8	0	1	1	1	H0524_008_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	8	0	1	1	1	H0524_008_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	8	0	1	1	1	H0524_008_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	8	0	1	1	1	H0524_008_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	8	0	1	1	1	H0524_008_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	8	0	1	1	1	H0524_008_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1846	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	8	0	1	1	1	H0524_008_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	8	0	1	1	1	H0524_008_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	10	0	2	1	1	H0524_010_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	10	0	2	1	1	H0524_010_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	10	0	2	1	1	H0524_010_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	10	0	2	1	1	H0524_010_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	10	0	2	1	1	H0524_010_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	10	0	2	1	1	H0524_010_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	10	0	2	1	1	H0524_010_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				2254	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	10	0	2	1	1	H0524_010_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	10	0	2	1	1	H0524_010_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	13	0	1	1	1	H0524_013_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	13	0	1	1	1	H0524_013_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	13	0	1	1	1	H0524_013_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	13	0	1	1	1	H0524_013_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	13	0	1	1	1	H0524_013_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	13	0	1	1	1	H0524_013_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	13	0	1	1	1	H0524_013_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1997	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	13	0	1	1	1	H0524_013_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	13	0	1	1	1	H0524_013_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	15	0	1	1	1	H0524_015_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	15	0	1	1	1	H0524_015_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	15	0	1	1	1	H0524_015_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	15	0	1	1	1	H0524_015_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	15	0	1	1	1	H0524_015_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	15	0	1	1	1	H0524_015_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	15	0	1	1	1	H0524_015_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1593	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	15	0	1	1	1	H0524_015_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	15	0	1	1	1	H0524_015_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	31	0	1	1	1	H0524_031_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	31	0	1	1	1	H0524_031_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	31	0	1	1	1	H0524_031_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	31	0	1	1	1	H0524_031_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	31	0	1	1	1	H0524_031_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	31	0	1	1	1	H0524_031_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	31	0	1	1	1	H0524_031_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				2207	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	31	0	1	1	1	H0524_031_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	31	0	1	1	1	H0524_031_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	32	0	1	1	1	H0524_032_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	32	0	1	1	1	H0524_032_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	32	0	1	1	1	H0524_032_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	32	0	1	1	1	H0524_032_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	32	0	1	1	1	H0524_032_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	32	0	1	1	1	H0524_032_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	32	0	1	1	1	H0524_032_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				2194	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	32	0	1	1	1	H0524_032_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	32	0	1	1	1	H0524_032_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	33	0	1	1	1	H0524_033_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	33	0	1	1	1	H0524_033_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	33	0	1	1	1	H0524_033_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	33	0	1	1	1	H0524_033_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	33	0	1	1	1	H0524_033_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	33	0	1	1	1	H0524_033_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	33	0	1	1	1	H0524_033_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1889	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	33	0	1	1	1	H0524_033_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	33	0	1	1	1	H0524_033_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	34	0	1	1	1	H0524_034_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	34	0	1	1	1	H0524_034_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	34	0	1	1	1	H0524_034_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	34	0	1	1	1	H0524_034_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	34	0	1	1	1	H0524_034_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	34	0	1	1	1	H0524_034_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	34	0	1	1	1	H0524_034_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1677	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	34	0	1	1	1	H0524_034_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	34	0	1	1	1	H0524_034_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	35	0	1	1	1	H0524_035_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	35	0	1	1	1	H0524_035_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	35	0	1	1	1	H0524_035_0	10	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	35	0	1	1	1	H0524_035_0	10	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	35	0	1	1	1	H0524_035_0	10	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	35	0	1	1	1	H0524_035_0	10	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	35	0	1	1	1	H0524_035_0	10	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1605	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	35	0	1	1	1	H0524_035_0	10	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	35	0	1	1	1	H0524_035_0	10	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	36	0	1	1	1	H0524_036_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	36	0	1	1	1	H0524_036_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	36	0	1	1	1	H0524_036_0	10	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	36	0	1	1	1	H0524_036_0	10	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	36	0	1	1	1	H0524_036_0	10	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	36	0	1	1	1	H0524_036_0	10	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	36	0	1	1	1	H0524_036_0	10	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1191	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	36	0	1	1	1	H0524_036_0	10	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	36	0	1	1	1	H0524_036_0	10	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	37	0	1	1	1	H0524_037_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	37	0	1	1	1	H0524_037_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	37	0	1	1	1	H0524_037_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	37	0	1	1	1	H0524_037_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	37	0	1	1	1	H0524_037_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	37	0	1	1	1	H0524_037_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	37	0	1	1	1	H0524_037_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1787	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	37	0	1	1	1	H0524_037_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	37	0	1	1	1	H0524_037_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	38	0	1	1	1	H0524_038_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	38	0	1	1	1	H0524_038_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	38	0	1	1	1	H0524_038_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	38	0	1	1	1	H0524_038_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	38	0	1	1	1	H0524_038_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	38	0	1	1	1	H0524_038_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	38	0	1	1	1	H0524_038_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1798	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	38	0	1	1	1	H0524_038_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	38	0	1	1	1	H0524_038_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	39	0	1	1	1	H0524_039_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	39	0	1	1	1	H0524_039_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	39	0	1	1	1	H0524_039_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	39	0	1	1	1	H0524_039_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	39	0	1	1	1	H0524_039_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	39	0	1	1	1	H0524_039_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	39	0	1	1	1	H0524_039_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				2017	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	39	0	1	1	1	H0524_039_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	39	0	1	1	1	H0524_039_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	40	0	1	1	1	H0524_040_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	40	0	1	1	1	H0524_040_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	40	0	1	1	1	H0524_040_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	40	0	1	1	1	H0524_040_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	40	0	1	1	1	H0524_040_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	40	0	1	1	1	H0524_040_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	40	0	1	1	1	H0524_040_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1832	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	40	0	1	1	1	H0524_040_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	40	0	1	1	1	H0524_040_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	41	0	1	1	1	H0524_041_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	41	0	1	1	1	H0524_041_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	41	0	1	1	1	H0524_041_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	41	0	1	1	1	H0524_041_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	41	0	1	1	1	H0524_041_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	41	0	1	1	1	H0524_041_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	41	0	1	1	1	H0524_041_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				2106	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	41	0	1	1	1	H0524_041_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	41	0	1	1	1	H0524_041_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	42	0	1	1	1	H0524_042_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	42	0	1	1	1	H0524_042_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	42	0	1	1	1	H0524_042_0	10	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	42	0	1	1	1	H0524_042_0	10	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	42	0	1	1	1	H0524_042_0	10	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	42	0	1	1	1	H0524_042_0	10	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	42	0	1	1	1	H0524_042_0	10	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1957	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	42	0	1	1	1	H0524_042_0	10	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	42	0	1	1	1	H0524_042_0	10	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	43	0	1	1	1	H0524_043_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	43	0	1	1	1	H0524_043_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	43	0	1	1	1	H0524_043_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	43	0	1	1	1	H0524_043_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	43	0	1	1	1	H0524_043_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	43	0	1	1	1	H0524_043_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	43	0	1	1	1	H0524_043_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1872	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	43	0	1	1	1	H0524_043_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	43	0	1	1	1	H0524_043_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	46	0	1	1	1	H0524_046_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	46	0	1	1	1	H0524_046_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	46	0	1	1	1	H0524_046_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	46	0	1	1	1	H0524_046_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	46	0	1	1	1	H0524_046_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	46	0	1	1	1	H0524_046_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	46	0	1	1	1	H0524_046_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1824	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	46	0	1	1	1	H0524_046_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	46	0	1	1	1	H0524_046_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	51	0	1	1	1	H0524_051_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	51	0	1	1	1	H0524_051_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	51	0	1	1	1	H0524_051_0	10	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	51	0	1	1	1	H0524_051_0	10	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	51	0	1	1	1	H0524_051_0	10	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	51	0	1	1	1	H0524_051_0	10	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	51	0	1	1	1	H0524_051_0	10	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				1576	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	51	0	1	1	1	H0524_051_0	10	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	51	0	1	1	1	H0524_051_0	10	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	54	0	1	1	1	H0524_054_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			3	6	6																6				6		0.2			0.1			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	54	0	1	1	1	H0524_054_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	6	12	18																			3	6	6																6				6		0.2			0.1			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	54	0	1	1	1	H0524_054_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			10	20	20																18				18		0.6			0.33			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	54	0	1	1	1	H0524_054_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				2	2	30	60	100				30		31	18	36	54																			10	20	20																18				18		0.6			0.33			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0524	54	0	1	1	1	H0524_054_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	54	0	1	1	1	H0524_054_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	54	0	1	1	1	H0524_054_0	9	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31				2003	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	54	0	1	1	1	H0524_054_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0524	54	0	1	1	1	H0524_054_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H0543	1	0	1	1	1	H0543_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	1	0	1	1	1	H0543_001_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	15		45																											45						30				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	1	0	1	1	1	H0543_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	1	0	1	1	1	H0543_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	1	0	1	1	1	H0543_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				875	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	13	0	1	1	1	H0543_013_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	13	0	1	1	1	H0543_013_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	13	0	1	1	1	H0543_013_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	13	0	1	1	1	H0543_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	13	0	1	1	1	H0543_013_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				794	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	19	0	1	1	1	H0543_019_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	15		45																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	19	0	1	1	1	H0543_019_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	20		60																											60						20				20				20		0.66						0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	19	0	1	1	1	H0543_019_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	19	0	1	1	1	H0543_019_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	19	0	1	1	1	H0543_019_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				743	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	22	0	1	1	1	H0543_022_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	22	0	1	1	1	H0543_022_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	22	0	1	1	1	H0543_022_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	22	0	1	1	1	H0543_022_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	22	0	1	1	1	H0543_022_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				783	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	28	0	1	1	1	H0543_028_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	28	0	1	1	1	H0543_028_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	28	0	1	1	1	H0543_028_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	28	0	1	1	1	H0543_028_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	28	0	1	1	1	H0543_028_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				786	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	29	0	1	1	1	H0543_029_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	29	0	1	1	1	H0543_029_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	29	0	1	1	1	H0543_029_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	29	0	1	1	1	H0543_029_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	29	0	1	1	1	H0543_029_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				671	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	32	0	1	1	1	H0543_032_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	32	0	1	1	1	H0543_032_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	32	0	1	1	1	H0543_032_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	32	0	1	1	1	H0543_032_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	32	0	1	1	1	H0543_032_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				963	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	35	0	1	1	1	H0543_035_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	35	0	1	1	1	H0543_035_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	35	0	1	1	1	H0543_035_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	35	0	1	1	1	H0543_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	35	0	1	1	1	H0543_035_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				822	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	36	0	1	1	1	H0543_036_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	36	0	1	1	1	H0543_036_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	36	0	1	1	1	H0543_036_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	36	0	1	1	1	H0543_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	36	0	1	1	1	H0543_036_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				584	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	60	0	1	1	1	H0543_060_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	60	0	1	1	1	H0543_060_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	60	0	1	1	1	H0543_060_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	60	0	1	1	1	H0543_060_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	60	0	1	1	1	H0543_060_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				897	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	70	0	1	1	1	H0543_070_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	70	0	1	1	1	H0543_070_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	70	0	1	1	1	H0543_070_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	70	0	1	1	1	H0543_070_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	70	0	1	1	1	H0543_070_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				708	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	86	0	1	1	1	H0543_086_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	86	0	1	1	1	H0543_086_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	86	0	1	1	1	H0543_086_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	86	0	1	1	1	H0543_086_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	86	0	1	1	1	H0543_086_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				949	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	89	0	1	1	1	H0543_089_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	89	0	1	1	1	H0543_089_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						10				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	89	0	1	1	1	H0543_089_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	89	0	1	1	1	H0543_089_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	89	0	1	1	1	H0543_089_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				955	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	138	0	1	1	1	H0543_138_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	138	0	1	1	1	H0543_138_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	138	0	1	1	1	H0543_138_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	138	0	1	1	1	H0543_138_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	138	0	1	1	1	H0543_138_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	138	0	1	1	1	H0543_138_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	138	0	1	1	1	H0543_138_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				949	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	140	0	1	1	1	H0543_140_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	140	0	1	1	1	H0543_140_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	140	0	1	1	1	H0543_140_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	140	0	1	1	1	H0543_140_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	140	0	1	1	1	H0543_140_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				616	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	144	0	1	1	1	H0543_144_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	144	0	1	1	1	H0543_144_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	144	0	1	1	1	H0543_144_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	144	0	1	1	1	H0543_144_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	144	0	1	1	1	H0543_144_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	144	0	1	1	1	H0543_144_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	144	0	1	1	1	H0543_144_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				947	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	145	0	1	1	1	H0543_145_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	145	0	1	1	1	H0543_145_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	145	0	1	1	1	H0543_145_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	145	0	1	1	1	H0543_145_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	145	0	1	1	1	H0543_145_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				908	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	146	0	1	1	1	H0543_146_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	146	0	1	1	1	H0543_146_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	146	0	1	1	1	H0543_146_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	146	0	1	1	1	H0543_146_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	146	0	1	1	1	H0543_146_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				870	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	147	0	1	1	1	H0543_147_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	147	0	1	1	1	H0543_147_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	147	0	1	1	1	H0543_147_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	147	0	1	1	1	H0543_147_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	147	0	1	1	1	H0543_147_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				607	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	148	0	1	1	1	H0543_148_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	148	0	1	1	1	H0543_148_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	148	0	1	1	1	H0543_148_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	148	0	1	1	1	H0543_148_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	148	0	1	1	1	H0543_148_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				848	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	151	0	1	1	1	H0543_151_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	151	0	1	1	1	H0543_151_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	12		36																											36						24				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	151	0	1	1	1	H0543_151_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	151	0	1	1	1	H0543_151_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	151	0	1	1	1	H0543_151_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				807	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	152	0	1	1	1	H0543_152_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	152	0	1	1	1	H0543_152_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	11		33																											33						0				11				11		0.36						0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	152	0	1	1	1	H0543_152_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	152	0	1	1	1	H0543_152_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	152	0	1	1	1	H0543_152_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				867	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	158	0	1	1	1	H0543_158_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	158	0	1	1	1	H0543_158_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	158	0	1	1	1	H0543_158_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	158	0	1	1	1	H0543_158_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	158	0	1	1	1	H0543_158_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				579	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	163	0	1	1	1	H0543_163_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	163	0	1	1	1	H0543_163_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	163	0	1	1	1	H0543_163_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	163	0	1	1	1	H0543_163_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	163	0	1	1	1	H0543_163_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				861	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	164	0	1	1	1	H0543_164_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	164	0	1	1	1	H0543_164_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	164	0	1	1	1	H0543_164_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	164	0	1	1	1	H0543_164_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0543	164	0	1	1	1	H0543_164_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	164	0	1	1	1	H0543_164_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	164	0	1	1	1	H0543_164_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				853	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	165	0	1	1	1	H0543_165_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	165	0	1	1	1	H0543_165_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	165	0	1	1	1	H0543_165_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	165	0	1	1	1	H0543_165_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0543	165	0	1	1	1	H0543_165_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	165	0	1	1	1	H0543_165_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	165	0	1	1	1	H0543_165_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				731	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	166	0	1	1	1	H0543_166_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	166	0	1	1	1	H0543_166_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	166	0	1	1	1	H0543_166_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	166	0	1	1	1	H0543_166_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0543	166	0	1	1	1	H0543_166_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	166	0	1	1	1	H0543_166_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	166	0	1	1	1	H0543_166_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				866	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	167	0	1	1	1	H0543_167_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	167	0	1	1	1	H0543_167_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	167	0	1	1	1	H0543_167_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	167	0	1	1	1	H0543_167_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	167	0	1	1	1	H0543_167_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				988	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	168	0	1	1	1	H0543_168_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	168	0	1	1	1	H0543_168_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	168	0	1	1	1	H0543_168_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	168	0	1	1	1	H0543_168_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	168	0	1	1	1	H0543_168_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	168	0	1	1	1	H0543_168_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	168	0	1	1	1	H0543_168_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				807	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	169	0	1	1	1	H0543_169_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	169	0	1	1	1	H0543_169_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	169	0	1	1	1	H0543_169_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	169	0	1	1	1	H0543_169_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	169	0	1	1	1	H0543_169_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	169	0	1	1	1	H0543_169_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	169	0	1	1	1	H0543_169_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				949	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	170	0	1	1	1	H0543_170_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	170	0	1	1	1	H0543_170_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	170	0	1	1	1	H0543_170_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	170	0	1	1	1	H0543_170_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	9		27																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0543	170	0	1	1	1	H0543_170_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	170	0	1	1	1	H0543_170_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	170	0	1	1	1	H0543_170_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				947	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	175	0	1	1	1	H0543_175_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	175	0	1	1	1	H0543_175_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	175	0	1	1	1	H0543_175_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	175	0	1	1	1	H0543_175_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	175	0	1	1	1	H0543_175_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				840	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	176	0	1	1	1	H0543_176_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	176	0	1	1	1	H0543_176_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	176	0	1	1	1	H0543_176_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	176	0	1	1	1	H0543_176_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	176	0	1	1	1	H0543_176_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				763	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	177	0	1	1	1	H0543_177_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	177	0	1	1	1	H0543_177_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	177	0	1	1	1	H0543_177_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	177	0	1	1	1	H0543_177_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	177	0	1	1	1	H0543_177_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				870	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	178	0	1	1	1	H0543_178_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	178	0	1	1	1	H0543_178_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	178	0	1	1	1	H0543_178_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	178	0	1	1	1	H0543_178_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	178	0	1	1	1	H0543_178_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				671	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	179	0	1	1	1	H0543_179_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	179	0	1	1	1	H0543_179_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	179	0	1	1	1	H0543_179_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	179	0	1	1	1	H0543_179_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	179	0	1	1	1	H0543_179_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				708	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	188	0	1	1	1	H0543_188_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	188	0	1	1	1	H0543_188_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	188	0	1	1	1	H0543_188_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	188	0	1	1	1	H0543_188_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	188	0	1	1	1	H0543_188_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				900	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	189	0	1	1	1	H0543_189_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	189	0	1	1	1	H0543_189_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	189	0	1	1	1	H0543_189_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	189	0	1	1	1	H0543_189_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	189	0	1	1	1	H0543_189_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				840	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	191	0	1	1	1	H0543_191_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	191	0	1	1	1	H0543_191_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	191	0	1	1	1	H0543_191_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	191	0	1	1	1	H0543_191_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	191	0	1	1	1	H0543_191_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				930	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	193	0	1	1	1	H0543_193_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	193	0	1	1	1	H0543_193_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	193	0	1	1	1	H0543_193_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	193	0	1	1	1	H0543_193_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	193	0	1	1	1	H0543_193_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				775	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	194	0	1	1	1	H0543_194_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	194	0	1	1	1	H0543_194_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	194	0	1	1	1	H0543_194_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	194	0	1	1	1	H0543_194_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	194	0	1	1	1	H0543_194_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				736	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	195	0	1	1	1	H0543_195_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	195	0	1	1	1	H0543_195_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	195	0	1	1	1	H0543_195_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	195	0	1	1	1	H0543_195_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	195	0	1	1	1	H0543_195_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				616	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	196	0	1	1	1	H0543_196_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	196	0	1	1	1	H0543_196_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	196	0	1	1	1	H0543_196_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	196	0	1	1	1	H0543_196_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	196	0	1	1	1	H0543_196_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				844	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	204	0	1	1	1	H0543_204_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		100	2	2						100	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	204	0	1	1	1	H0543_204_0	4	Generic	4	1	1	2	2	1		110	1		100	1				30		100	2	2						100	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	204	0	1	1	1	H0543_204_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		100	2	2						100	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	204	0	1	1	1	H0543_204_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		100	2	2						100	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0543	204	0	1	1	1	H0543_204_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		100	2	2						100	30		31											907	28		28				763	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	2	0	1	1	1	H0544_002_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	2	0	1	1	1	H0544_002_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	2	0	1	1	1	H0544_002_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	9.5	19	28.5																			9.5	19	19																9.5				9.5		0.32			0.32			0.28	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	2	0	1	1	1	H0544_002_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	9.5	19	28.5																			9.5	19	19																9.5				9.5		0.32			0.32			0.28	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	2	0	1	1	1	H0544_002_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	37.5	75	112.5																			37.5	75	75																37.5				37.5		1.25			1.25			1.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	2	0	1	1	1	H0544_002_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	2	0	1	1	1	H0544_002_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	2	0	1	1	1	H0544_002_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	2	0	1	1	1	H0544_002_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	3	0	1	1	1	H0544_003_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	3	0	1	1	1	H0544_003_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	3	0	1	1	1	H0544_003_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	3	0	1	1	1	H0544_003_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	3	0	1	1	1	H0544_003_0	10	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				58.05	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	3	0	1	1	1	H0544_003_0	10	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				51.53	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	3	0	1	1	1	H0544_003_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	3	0	1	1	1	H0544_003_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	3	0	1	1	1	H0544_003_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	4	0	1	1	1	H0544_004_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	4	0	1	1	1	H0544_004_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	4	0	1	1	1	H0544_004_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	4	0	1	1	1	H0544_004_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	4	0	1	1	1	H0544_004_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	37.5	75	112.5																			37.5	75	75																37.5				37.5		1.25			1.25			1.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	4	0	1	1	1	H0544_004_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	4	0	1	1	1	H0544_004_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	4	0	1	1	1	H0544_004_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	4	0	1	1	1	H0544_004_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	5	0	1	1	1	H0544_005_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	5	0	1	1	1	H0544_005_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	5	0	1	1	1	H0544_005_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	9.5	19	28.5																			9.5	19	19																9.5				9.5		0.32			0.32			0.28	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	5	0	1	1	1	H0544_005_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	9.5	19	28.5																			9.5	19	19																9.5				9.5		0.32			0.32			0.28	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	5	0	1	1	1	H0544_005_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	37.5	75	112.5																			37.5	75	75																37.5				37.5		1.25			1.25			1.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	5	0	1	1	1	H0544_005_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	5	0	1	1	1	H0544_005_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	5	0	1	1	1	H0544_005_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	5	0	1	1	1	H0544_005_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	7	0	1	1	1	H0544_007_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	5	10	15																			5	10	10																5				5		0.17			0.17			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	7	0	1	1	1	H0544_007_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	14.5	29	43.5																			14.5	29	29																14.5				14.5		0.48			0.48			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	7	0	1	1	1	H0544_007_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	45	90	135																			45	90	90																45				45		1.5			1.5			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	7	0	1	1	1	H0544_007_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	95	190	285																			95	190	190																95				95		3.17			3.17			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	7	0	1	1	1	H0544_007_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	7	0	1	1	1	H0544_007_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	10	20	30																			10	20	20																10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	8	0	1	1	1	H0544_008_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	8	0	1	1	1	H0544_008_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	8	0	1	1	1	H0544_008_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	8	0	1	1	1	H0544_008_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	8	0	1	1	1	H0544_008_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	8	0	1	1	1	H0544_008_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	8	0	1	1	1	H0544_008_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	8	0	1	1	1	H0544_008_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	8	0	1	1	1	H0544_008_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	10	0	1	1	1	H0544_010_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	10	0	1	1	1	H0544_010_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	10	0	1	1	1	H0544_010_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	10	0	1	1	1	H0544_010_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	10	0	1	1	1	H0544_010_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	10	0	1	1	1	H0544_010_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	10	0	1	1	1	H0544_010_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	10	0	1	1	1	H0544_010_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	10	0	1	1	1	H0544_010_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	12	0	1	1	1	H0544_012_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	12	0	1	1	1	H0544_012_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	12	0	1	1	1	H0544_012_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	12	0	1	1	1	H0544_012_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	12	0	1	1	1	H0544_012_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	12	0	1	1	1	H0544_012_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	12	0	1	1	1	H0544_012_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	12	0	1	1	1	H0544_012_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	12	0	1	1	1	H0544_012_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	13	0	1	1	1	H0544_013_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	13	0	1	1	1	H0544_013_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	13	0	1	1	1	H0544_013_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	13	0	1	1	1	H0544_013_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	13	0	1	1	1	H0544_013_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	37.5	75	112.5																			37.5	75	75																37.5				37.5		1.25			1.25			1.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	13	0	1	1	1	H0544_013_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	13	0	1	1	1	H0544_013_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	13	0	1	1	1	H0544_013_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	13	0	1	1	1	H0544_013_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	14	0	1	1	1	H0544_014_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	14	0	1	1	1	H0544_014_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	14	0	1	1	1	H0544_014_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	14	0	1	1	1	H0544_014_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	14	0	1	1	1	H0544_014_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	37.5	75	112.5																			37.5	75	75																37.5				37.5		1.25			1.25			1.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	14	0	1	1	1	H0544_014_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	14	0	1	1	1	H0544_014_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	14	0	1	1	1	H0544_014_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	14	0	1	1	1	H0544_014_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	15	0	1	1	1	H0544_015_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	15	0	1	1	1	H0544_015_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	15	0	1	1	1	H0544_015_0	9	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	15	0	1	1	1	H0544_015_0	9	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	15	0	1	1	1	H0544_015_0	9	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	37.5	75	112.5																			37.5	75	75																37.5				37.5		1.25			1.25			1.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	15	0	1	1	1	H0544_015_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	15	0	1	1	1	H0544_015_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	15	0	1	1	1	H0544_015_0	9	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	15	0	1	1	1	H0544_015_0	9	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	19	0	1	1	1	H0544_019_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	19	0	1	1	1	H0544_019_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	19	0	1	1	1	H0544_019_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	19	0	1	1	1	H0544_019_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	19	0	1	1	1	H0544_019_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	19	0	1	1	1	H0544_019_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	19	0	1	1	1	H0544_019_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	19	0	1	1	1	H0544_019_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	19	0	1	1	1	H0544_019_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	20	0	1	1	1	H0544_020_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	20	0	1	1	1	H0544_020_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	20	0	1	1	1	H0544_020_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	20	0	1	1	1	H0544_020_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	20	0	1	1	1	H0544_020_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	20	0	1	1	1	H0544_020_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	20	0	1	1	1	H0544_020_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	20	0	1	1	1	H0544_020_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	20	0	1	1	1	H0544_020_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	21	0	1	1	1	H0544_021_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	21	0	1	1	1	H0544_021_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17.5	35	52.5					12.5	25	37.5					12.5	25	25																17.5				17.5			0.58	0.42	0.42			0.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	21	0	1	1	1	H0544_021_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	21	0	1	1	1	H0544_021_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					90	180	270					90	180	180																95				95			3.17	3	3			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	21	0	1	1	1	H0544_021_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	21	0	1	1	1	H0544_021_0	11	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					10	20	30					10	20	20																10				10			0.33	0.33	0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	24	0	1	1	1	H0544_024_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	24	0	1	1	1	H0544_024_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	24	0	1	1	1	H0544_024_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	24	0	1	1	1	H0544_024_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	24	0	1	1	1	H0544_024_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	24	0	1	1	1	H0544_024_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	24	0	1	1	1	H0544_024_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	24	0	1	1	1	H0544_024_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	24	0	1	1	1	H0544_024_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	25	0	1	1	1	H0544_025_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	25	0	1	1	1	H0544_025_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	25	0	1	1	1	H0544_025_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	25	0	1	1	1	H0544_025_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	25	0	1	1	1	H0544_025_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	25	0	1	1	1	H0544_025_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	25	0	1	1	1	H0544_025_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	25	0	1	1	1	H0544_025_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	25	0	1	1	1	H0544_025_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	27	0	1	1	1	H0544_027_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	27	0	1	1	1	H0544_027_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	27	0	1	1	1	H0544_027_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	27	0	1	1	1	H0544_027_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	27	0	1	1	1	H0544_027_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	27	0	1	1	1	H0544_027_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	27	0	1	1	1	H0544_027_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	27	0	1	1	1	H0544_027_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	27	0	1	1	1	H0544_027_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	31	0	1	1	1	H0544_031_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	31	0	1	1	1	H0544_031_0	11	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	31	0	1	1	1	H0544_031_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	31	0	1	1	1	H0544_031_0	11	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	31	0	1	1	1	H0544_031_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	31	0	1	1	1	H0544_031_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	31	0	1	1	1	H0544_031_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	31	0	1	1	1	H0544_031_0	11	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	31	0	1	1	1	H0544_031_0	11	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	32	0	1	1	1	H0544_032_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	32	0	1	1	1	H0544_032_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	32	0	1	1	1	H0544_032_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	32	0	1	1	1	H0544_032_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	32	0	1	1	1	H0544_032_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	32	0	1	1	1	H0544_032_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	32	0	1	1	1	H0544_032_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	32	0	1	1	1	H0544_032_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	32	0	1	1	1	H0544_032_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	36	0	1	1	1	H0544_036_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	36	0	1	1	1	H0544_036_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	36	0	1	1	1	H0544_036_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	36	0	1	1	1	H0544_036_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	36	0	1	1	1	H0544_036_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	36	0	1	1	1	H0544_036_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	36	0	1	1	1	H0544_036_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	36	0	1	1	1	H0544_036_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	36	0	1	1	1	H0544_036_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	37	0	1	1	1	H0544_037_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	37	0	1	1	1	H0544_037_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	37	0	1	1	1	H0544_037_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	37	0	1	1	1	H0544_037_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	37	0	1	1	1	H0544_037_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	37	0	1	1	1	H0544_037_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	37	0	1	1	1	H0544_037_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	37	0	1	1	1	H0544_037_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	37	0	1	1	1	H0544_037_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	38	0	1	1	1	H0544_038_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	38	0	1	1	1	H0544_038_0	11	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	38	0	1	1	1	H0544_038_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	38	0	1	1	1	H0544_038_0	11	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	38	0	1	1	1	H0544_038_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	38	0	1	1	1	H0544_038_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	38	0	1	1	1	H0544_038_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	38	0	1	1	1	H0544_038_0	11	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	38	0	1	1	1	H0544_038_0	11	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	49	0	1	1	1	H0544_049_0	13	Preferred Generic	4	1	1	1	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34				1.23	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	49	0	1	1	1	H0544_049_0	13	Generic	4	1	1	1	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				4.81	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	49	0	1	1	1	H0544_049_0	13	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				56.18	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	49	0	1	1	1	H0544_049_0	13	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				55.75	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	49	0	1	1	1	H0544_049_0	13	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	49	0	1	1	1	H0544_049_0	13	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	49	0	1	1	1	H0544_049_0	13	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	50	0	1	1	1	H0544_050_0	11	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	50	0	1	1	1	H0544_050_0	11	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	50	0	1	1	1	H0544_050_0	11	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	50	0	1	1	1	H0544_050_0	11	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	50	0	1	1	1	H0544_050_0	11	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	50	0	1	1	1	H0544_050_0	11	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	50	0	1	1	1	H0544_050_0	11	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	50	0	1	1	1	H0544_050_0	11	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	50	0	1	1	1	H0544_050_0	11	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	52	0	1	1	1	H0544_052_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	52	0	1	1	1	H0544_052_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	52	0	1	1	1	H0544_052_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	52	0	1	1	1	H0544_052_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	52	0	1	1	1	H0544_052_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	52	0	1	1	1	H0544_052_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	53	0	1	1	1	H0544_053_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	53	0	1	1	1	H0544_053_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	53	0	1	1	1	H0544_053_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	53	0	1	1	1	H0544_053_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	53	0	1	1	1	H0544_053_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	53	0	1	1	1	H0544_053_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	54	0	1	1	1	H0544_054_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	54	0	1	1	1	H0544_054_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H0544	54	0	1	1	1	H0544_054_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					9	18	27					9	27	27																9				9			0.3	0.3	0.3			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	54	0	1	1	1	H0544_054_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	54	0	1	1	1	H0544_054_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	54	0	1	1	1	H0544_054_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	54	0	1	1	1	H0544_054_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	54	0	1	1	1	H0544_054_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	55	0	1	1	1	H0544_055_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	55	0	1	1	1	H0544_055_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	55	0	1	1	1	H0544_055_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	55	0	1	1	1	H0544_055_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	55	0	1	1	1	H0544_055_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	55	0	1	1	1	H0544_055_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	56	0	1	1	1	H0544_056_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	56	0	1	1	1	H0544_056_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	56	0	1	1	1	H0544_056_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	56	0	1	1	1	H0544_056_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	56	0	1	1	1	H0544_056_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	56	0	1	1	1	H0544_056_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	56	0	1	1	1	H0544_056_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	57	0	1	1	1	H0544_057_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	57	0	1	1	1	H0544_057_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	57	0	1	1	1	H0544_057_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	16	16																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	57	0	1	1	1	H0544_057_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	57	0	1	1	1	H0544_057_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	57	0	1	1	1	H0544_057_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	58	0	1	1	1	H0544_058_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	58	0	1	1	1	H0544_058_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	58	0	1	1	1	H0544_058_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					5	10	15					0	0	0																10				10			0.33	0.17	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	58	0	1	1	1	H0544_058_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	58	0	1	1	1	H0544_058_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	58	0	1	1	1	H0544_058_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	59	0	1	1	1	H0544_059_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	59	0	1	1	1	H0544_059_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	59	0	1	1	1	H0544_059_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					5	10	15					0	0	0																10				10			0.33	0.17	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	59	0	1	1	1	H0544_059_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	59	0	1	1	1	H0544_059_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	59	0	1	1	1	H0544_059_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	60	3	1	1	1	H0544_060_3	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								12	24	36					7	14	21					7	21	21																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	3	1	1	1	H0544_060_3	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	3	1	1	1	H0544_060_3	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	3	1	1	1	H0544_060_3	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	3	1	1	1	H0544_060_3	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	3	1	1	1	H0544_060_3	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	3	1	1	1	H0544_060_3	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	60	4	1	1	1	H0544_060_4	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								12	24	36					7	14	21					7	21	21																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	4	1	1	1	H0544_060_4	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	4	1	1	1	H0544_060_4	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	4	1	1	1	H0544_060_4	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	4	1	1	1	H0544_060_4	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	4	1	1	1	H0544_060_4	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	60	4	1	1	1	H0544_060_4	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	61	0	1	1	1	H0544_061_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								12	24	36					7	14	21					7	21	21																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	61	0	1	1	1	H0544_061_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	61	0	1	1	1	H0544_061_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	61	0	1	1	1	H0544_061_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	61	0	1	1	1	H0544_061_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	61	0	1	1	1	H0544_061_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	61	0	1	1	1	H0544_061_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	62	0	1	1	1	H0544_062_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	62	0	1	1	1	H0544_062_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	62	0	1	1	1	H0544_062_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	62	0	1	1	1	H0544_062_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	62	0	1	1	1	H0544_062_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	62	0	1	1	1	H0544_062_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	63	0	1	1	1	H0544_063_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					2	4	6					2	6	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	63	0	1	1	1	H0544_063_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					5	10	15					5	15	15																14				14			0.47	0.17	0.17			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	63	0	1	1	1	H0544_063_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	63	0	1	1	1	H0544_063_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	63	0	1	1	1	H0544_063_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	63	0	1	1	1	H0544_063_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	63	0	1	1	1	H0544_063_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	64	0	1	1	1	H0544_064_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	64	0	1	1	1	H0544_064_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	64	0	1	1	1	H0544_064_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	64	0	1	1	1	H0544_064_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	64	0	1	1	1	H0544_064_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	64	0	1	1	1	H0544_064_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	64	0	1	1	1	H0544_064_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	65	0	1	1	1	H0544_065_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	65	0	1	1	1	H0544_065_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					7	14	21					7	21	21																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	65	0	1	1	1	H0544_065_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	65	0	1	1	1	H0544_065_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	65	0	1	1	1	H0544_065_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	65	0	1	1	1	H0544_065_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	65	0	1	1	1	H0544_065_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	66	0	1	1	1	H0544_066_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	66	0	1	1	1	H0544_066_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	66	0	1	1	1	H0544_066_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					5	10	15					0	0	0																10				10			0.33	0.17	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	66	0	1	1	1	H0544_066_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	66	0	1	1	1	H0544_066_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	66	0	1	1	1	H0544_066_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	67	0	1	1	1	H0544_067_0	9	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	67	0	1	1	1	H0544_067_0	9	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	67	0	1	1	1	H0544_067_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					5	10	15					0	0	0																10				10			0.33	0.17	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	67	0	1	1	1	H0544_067_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	67	0	1	1	1	H0544_067_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	67	0	1	1	1	H0544_067_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	69	0	1	1	1	H0544_069_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	69	0	1	1	1	H0544_069_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	69	0	1	1	1	H0544_069_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	69	0	1	1	1	H0544_069_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	69	0	1	1	1	H0544_069_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	69	0	1	1	1	H0544_069_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	70	0	1	1	1	H0544_070_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	70	0	1	1	1	H0544_070_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	70	0	1	1	1	H0544_070_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					9	18	27					9	27	27																9				9			0.3	0.3	0.3			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	70	0	1	1	1	H0544_070_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	70	0	1	1	1	H0544_070_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	70	0	1	1	1	H0544_070_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	71	0	1	1	1	H0544_071_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	71	0	1	1	1	H0544_071_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	71	0	1	1	1	H0544_071_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					12	24	36					12	36	36																12				12			0.4	0.4	0.4			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	71	0	1	1	1	H0544_071_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	71	0	1	1	1	H0544_071_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	71	0	1	1	1	H0544_071_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	72	0	1	1	1	H0544_072_0	10	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	72	0	1	1	1	H0544_072_0	10	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	72	0	1	1	1	H0544_072_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	72	0	1	1	1	H0544_072_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	72	0	1	1	1	H0544_072_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	72	0	1	1	1	H0544_072_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	74	0	1	1	1	H0544_074_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	74	0	1	1	1	H0544_074_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	74	0	1	1	1	H0544_074_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	74	0	1	1	1	H0544_074_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	74	0	1	1	1	H0544_074_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	74	0	1	1	1	H0544_074_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	74	0	1	1	1	H0544_074_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	81	0	1	1	1	H0544_081_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	81	0	1	1	1	H0544_081_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	81	0	1	1	1	H0544_081_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								2	4	6					2	4	6					2	6	6																2				2			0.07	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	81	0	1	1	1	H0544_081_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	81	0	1	1	1	H0544_081_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	81	0	1	1	1	H0544_081_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	87	0	1	1	1	H0544_087_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	87	0	1	1	1	H0544_087_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	87	0	1	1	1	H0544_087_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	30	30																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	87	0	1	1	1	H0544_087_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	87	0	1	1	1	H0544_087_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	87	0	1	1	1	H0544_087_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	88	0	1	1	1	H0544_088_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	88	0	1	1	1	H0544_088_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	88	0	1	1	1	H0544_088_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	88	0	1	1	1	H0544_088_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	88	0	1	1	1	H0544_088_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	88	0	1	1	1	H0544_088_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	89	0	1	1	1	H0544_089_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	89	0	1	1	1	H0544_089_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	89	0	1	1	1	H0544_089_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	89	0	1	1	1	H0544_089_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	89	0	1	1	1	H0544_089_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	89	0	1	1	1	H0544_089_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	90	0	1	1	1	H0544_090_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	90	0	1	1	1	H0544_090_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	90	0	1	1	1	H0544_090_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	90	0	1	1	1	H0544_090_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	90	0	1	1	1	H0544_090_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	90	0	1	1	1	H0544_090_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	91	0	1	1	1	H0544_091_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	91	0	1	1	1	H0544_091_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	91	0	1	1	1	H0544_091_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					7	14	21					7	14	14																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	91	0	1	1	1	H0544_091_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	91	0	1	1	1	H0544_091_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	91	0	1	1	1	H0544_091_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	93	0	1	1	1	H0544_093_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	93	0	1	1	1	H0544_093_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	93	0	1	1	1	H0544_093_0	9	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	93	0	1	1	1	H0544_093_0	9	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	93	0	1	1	1	H0544_093_0	9	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	93	0	1	1	1	H0544_093_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	93	0	1	1	1	H0544_093_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	93	0	1	1	1	H0544_093_0	9	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	93	0	1	1	1	H0544_093_0	9	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	94	0	1	1	1	H0544_094_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	94	0	1	1	1	H0544_094_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	94	0	1	1	1	H0544_094_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	94	0	1	1	1	H0544_094_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	94	0	1	1	1	H0544_094_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	94	0	1	1	1	H0544_094_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	94	0	1	1	1	H0544_094_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	94	0	1	1	1	H0544_094_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	94	0	1	1	1	H0544_094_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H0544	95	0	1	1	1	H0544_095_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	95	0	1	1	1	H0544_095_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	95	0	1	1	1	H0544_095_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	95	0	1	1	1	H0544_095_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	95	0	1	1	1	H0544_095_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	95	0	1	1	1	H0544_095_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	95	0	1	1	1	H0544_095_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0544	96	0	1	1	1	H0544_096_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	96	0	1	1	1	H0544_096_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	96	0	1	1	1	H0544_096_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	96	0	1	1	1	H0544_096_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	96	0	1	1	1	H0544_096_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	96	0	1	1	1	H0544_096_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	97	0	1	1	1	H0544_097_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	97	0	1	1	1	H0544_097_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	97	0	1	1	1	H0544_097_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	24	24																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	97	0	1	1	1	H0544_097_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	97	0	1	1	1	H0544_097_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	97	0	1	1	1	H0544_097_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	98	0	1	1	1	H0544_098_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	98	0	1	1	1	H0544_098_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0544	98	0	1	1	1	H0544_098_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	98	0	1	1	1	H0544_098_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	98	0	1	1	1	H0544_098_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	98	0	1	1	1	H0544_098_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	99	0	1	1	1	H0544_099_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	99	0	1	1	1	H0544_099_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0544	99	0	1	1	1	H0544_099_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					13	26	39					13	39	39																13				13			0.43	0.43	0.43			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	99	0	1	1	1	H0544_099_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	99	0	1	1	1	H0544_099_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	99	0	1	1	1	H0544_099_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0544	100	0	1	1	1	H0544_100_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	100	0	1	1	1	H0544_100_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H0544	100	0	1	1	1	H0544_100_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								8	16	24					8	16	24					8	24	24																8				8			0.27	0.27	0.27			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	100	0	1	1	1	H0544_100_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	100	0	1	1	1	H0544_100_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	100	0	1	1	1	H0544_100_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	100	0	1	1	1	H0544_100_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0544	100	0	1	1	1	H0544_100_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0545	1	0	1	1	1	H0545_001_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	1			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0545	1	0	1	1	1	H0545_001_0	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	1			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H0545	1	0	1	1	1	H0545_001_0	8	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	1			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0545	1	0	1	1	1	H0545_001_0	8	Generic	4	1	3	2	2	3	110		1	100		1	30		90				2	1			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H0545	1	0	1	1	1	H0545_001_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	1			90				30		31	47		141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0545	1	0	1	1	1	H0545_001_0	8	Non-Preferred Drug	4	11	3	1	4	1	110		1	100		1	30		90				2	1			90				30		31				56.83	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0545	1	0	1	1	1	H0545_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				983.36	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0545	1	0	1	1	1	H0545_001_0	8	Select Diabetic Drugs	4	11	1	2	6	1	110		1	100		1	30		90				2	1			90				30		31	11		33																					22																11				11		0.37						0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H0545	1	0	1	1	1	H0545_001_0	8	Select Diabetic Drugs	4	11	1	2	6	3	110		1	100		1	30		90				2	1			90				30		31	11		33																					22																11				11		0.37						0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H0545	12	0	1	1	1	H0545_012_0	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	1			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0545	12	0	1	1	1	H0545_012_0	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	1			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0545	12	0	1	1	1	H0545_012_0	4	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	1			90				30		31	12		36																					36																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0545	12	0	1	1	1	H0545_012_0	4	Generic	4	1	3	2	2	3	110		1	100		1	30		90				2	1			90				30		31	12		36																					36																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H0545	12	0	1	1	1	H0545_012_0	4	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	1			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0545	12	0	1	1	1	H0545_012_0	4	Non-Preferred Drug	4	11	3	1	4	1	110		1	100		1	30		90				2	1			90				30		31				48.38	30		30																				30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0545	12	0	1	1	1	H0545_012_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				572.79	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0545	12	0	1	1	1	H0545_012_0	4	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				2	1	30		90				30		31	11		33																			11		33																11				11		0.37			0.37			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0545	12	0	1	1	1	H0545_012_0	4	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				2	1	30		90				30		31	11		33																			11		33																11				11		0.37			0.37			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0545	15	0	1	1	1	H0545_015_0	4	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				2	1			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0545	15	0	1	1	1	H0545_015_0	4	Generic	2	1	1	1	2	1	110		1	100		1	30		90				2	1			90				30		31				6.59	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0545	15	0	1	1	1	H0545_015_0	4	Preferred Brand	2	10	1	1	3	1	110		1	100		1	30		90				2	1			90				30		31				85.15	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0545	15	0	1	1	1	H0545_015_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				2	1			90				30		31				112.57	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0545	15	0	1	1	1	H0545_015_0	4	Specialty Tier	2	11	1	1	5	1	10		1			1	30														30		31				715.99	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0562	9	0	1	1	1	H0562_009_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	9	0	1	1	1	H0562_009_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					7	14	21					7	14	14																18				18			0.6	0.23	0.23			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	9	0	1	1	1	H0562_009_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	9	0	1	1	1	H0562_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	9	0	1	1	1	H0562_009_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	9	0	1	1	1	H0562_009_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	12	0	1	1	1	H0562_012_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	12	0	1	1	1	H0562_012_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	24																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	12	0	1	1	1	H0562_012_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	12	0	1	1	1	H0562_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	12	0	1	1	1	H0562_012_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	12	0	1	1	1	H0562_012_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	39	0	1	1	1	H0562_039_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	14																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	39	0	1	1	1	H0562_039_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								19	38	57					12	24	36					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	39	0	1	1	1	H0562_039_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	39	0	1	1	1	H0562_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	39	0	1	1	1	H0562_039_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	39	0	1	1	1	H0562_039_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	55	0	1	1	1	H0562_055_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	55	0	1	1	1	H0562_055_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	55	0	1	1	1	H0562_055_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	55	0	1	1	1	H0562_055_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	55	0	1	1	1	H0562_055_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	55	0	1	1	1	H0562_055_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	68	0	1	1	1	H0562_068_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	68	0	1	1	1	H0562_068_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	68	0	1	1	1	H0562_068_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	68	0	1	1	1	H0562_068_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	68	0	1	1	1	H0562_068_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	68	0	1	1	1	H0562_068_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	79	0	1	1	1	H0562_079_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	79	0	1	1	1	H0562_079_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	79	0	1	1	1	H0562_079_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	79	0	1	1	1	H0562_079_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	79	0	1	1	1	H0562_079_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	79	0	1	1	1	H0562_079_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	84	0	1	1	1	H0562_084_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	84	0	1	1	1	H0562_084_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					13	26	39					13	26	26																18				18			0.6	0.43	0.43			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	84	0	1	1	1	H0562_084_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	84	0	1	1	1	H0562_084_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	84	0	1	1	1	H0562_084_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	84	0	1	1	1	H0562_084_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	90	0	1	1	1	H0562_090_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	90	0	1	1	1	H0562_090_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	90	0	1	1	1	H0562_090_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	90	0	1	1	1	H0562_090_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	90	0	1	1	1	H0562_090_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	90	0	1	1	1	H0562_090_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	92	0	1	1	1	H0562_092_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	92	0	1	1	1	H0562_092_0	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	92	0	1	1	1	H0562_092_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	92	0	1	1	1	H0562_092_0	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	92	0	1	1	1	H0562_092_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	92	0	1	1	1	H0562_092_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	92	0	1	1	1	H0562_092_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	92	0	1	1	1	H0562_092_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	92	0	1	1	1	H0562_092_0	4	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	97	0	1	1	1	H0562_097_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					5	10	15					5	10	10																8				8			0.27	0.17	0.17			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	97	0	1	1	1	H0562_097_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					12	24	36					12	24	24																15				15			0.5	0.4	0.4			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	97	0	1	1	1	H0562_097_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	97	0	1	1	1	H0562_097_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	97	0	1	1	1	H0562_097_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	97	0	1	1	1	H0562_097_0	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	1	1	1	1	H0562_100_1	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	1	1	1	1	H0562_100_1	5	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	100	1	1	1	1	H0562_100_1	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	1	1	1	1	H0562_100_1	5	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	100	1	1	1	1	H0562_100_1	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	1	1	1	1	H0562_100_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	1	1	1	1	H0562_100_1	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	1	1	1	1	H0562_100_1	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	1	1	1	1	H0562_100_1	5	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	100	2	1	1	1	H0562_100_2	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	2	1	1	1	H0562_100_2	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	100	2	1	1	1	H0562_100_2	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	2	1	1	1	H0562_100_2	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	100	2	1	1	1	H0562_100_2	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	2	1	1	1	H0562_100_2	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	2	1	1	1	H0562_100_2	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	2	1	1	1	H0562_100_2	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	100	2	1	1	1	H0562_100_2	4	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	101	1	1	1	1	H0562_101_1	4	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	1	1	1	1	H0562_101_1	4	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H0562	101	1	1	1	1	H0562_101_1	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	1	1	1	1	H0562_101_1	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	101	1	1	1	1	H0562_101_1	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	1	1	1	1	H0562_101_1	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	1	1	1	1	H0562_101_1	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	1	1	1	1	H0562_101_1	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	1	1	1	1	H0562_101_1	4	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	101	2	1	1	1	H0562_101_2	4	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	2	1	1	1	H0562_101_2	4	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H0562	101	2	1	1	1	H0562_101_2	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	2	1	1	1	H0562_101_2	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	101	2	1	1	1	H0562_101_2	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	2	1	1	1	H0562_101_2	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	2	1	1	1	H0562_101_2	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	2	1	1	1	H0562_101_2	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	101	2	1	1	1	H0562_101_2	4	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0562	103	0	1	1	1	H0562_103_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								13	26	39					8	16	24					8	16	16																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	103	0	1	1	1	H0562_103_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	103	0	1	1	1	H0562_103_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	103	0	1	1	1	H0562_103_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	103	0	1	1	1	H0562_103_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	103	0	1	1	1	H0562_103_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	112	0	1	1	1	H0562_112_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	112	0	1	1	1	H0562_112_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					5	10	15					5	10	10																20				20			0.67	0.17	0.17			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	112	0	1	1	1	H0562_112_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	112	0	1	1	1	H0562_112_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	112	0	1	1	1	H0562_112_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	112	0	1	1	1	H0562_112_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	113	0	1	1	1	H0562_113_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	113	0	1	1	1	H0562_113_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	113	0	1	1	1	H0562_113_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	113	0	1	1	1	H0562_113_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	113	0	1	1	1	H0562_113_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	113	0	1	1	1	H0562_113_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	114	0	1	1	1	H0562_114_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	114	0	1	1	1	H0562_114_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	24																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	114	0	1	1	1	H0562_114_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	114	0	1	1	1	H0562_114_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	114	0	1	1	1	H0562_114_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	114	0	1	1	1	H0562_114_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	117	0	1	1	1	H0562_117_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					0	0	0					3	6	6																8				8			0.27	0	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	117	0	1	1	1	H0562_117_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	117	0	1	1	1	H0562_117_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					37	74	101																47				47			1.57	1.4	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	117	0	1	1	1	H0562_117_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					90	180	260																100				100			3.33	3.17	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	117	0	1	1	1	H0562_117_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	117	0	1	1	1	H0562_117_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	118	0	1	1	1	H0562_118_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	118	0	1	1	1	H0562_118_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					5	10	15					5	10	10																20				20			0.67	0.17	0.17			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	118	0	1	1	1	H0562_118_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	118	0	1	1	1	H0562_118_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	118	0	1	1	1	H0562_118_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	118	0	1	1	1	H0562_118_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	119	0	1	1	1	H0562_119_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	9					5	10	10																10				10			0.33	0.1	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	119	0	1	1	1	H0562_119_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	119	0	1	1	1	H0562_119_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	119	0	1	1	1	H0562_119_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	119	0	1	1	1	H0562_119_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	119	0	1	1	1	H0562_119_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	120	0	1	1	1	H0562_120_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	120	0	1	1	1	H0562_120_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	120	0	1	1	1	H0562_120_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					37	74	101																47				47			1.57	1.33	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	120	0	1	1	1	H0562_120_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	120	0	1	1	1	H0562_120_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	120	0	1	1	1	H0562_120_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	121	0	1	1	1	H0562_121_0	5	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	121	0	1	1	1	H0562_121_0	5	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	121	0	1	1	1	H0562_121_0	5	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	121	0	1	1	1	H0562_121_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	121	0	1	1	1	H0562_121_0	5	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	121	0	1	1	1	H0562_121_0	5	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	122	0	1	1	1	H0562_122_0	5	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	122	0	1	1	1	H0562_122_0	5	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	122	0	1	1	1	H0562_122_0	5	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	122	0	1	1	1	H0562_122_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	122	0	1	1	1	H0562_122_0	5	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0562	122	0	1	1	1	H0562_122_0	5	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0571	1	0	1	1	1	H0571_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								3	6	9					3	6	6							6																	3			3			0.1	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0571	1	0	1	1	1	H0571_001_0	4	Generic	4	1	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								7	14	21					7	14	14							14																	7			7			0.23	0.23				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0571	1	0	1	1	1	H0571_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								40	80	120					40	80	80							80																	40			40			1.33	1.33				1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0571	1	0	1	1	1	H0571_001_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10	100		1				30	60	90	1	2			90					14	31								60	120	180					60	120	120							120																	60			60			2	2				1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0571	1	0	1	1	1	H0571_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							14	31												30							30						30																		30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H0609	7	0	1	1	1	H0609_007_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	7	0	1	1	1	H0609_007_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	7	0	1	1	1	H0609_007_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	7	0	1	1	1	H0609_007_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	7	0	1	1	1	H0609_007_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				1055	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	12	0	1	1	1	H0609_012_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	12	0	1	1	1	H0609_012_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	12	0	1	1	1	H0609_012_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	12	0	1	1	1	H0609_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	12	0	1	1	1	H0609_012_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				875	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	25	0	1	1	1	H0609_025_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	25	0	1	1	1	H0609_025_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	25	0	1	1	1	H0609_025_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	25	0	1	1	1	H0609_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	25	0	1	1	1	H0609_025_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				973	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	26	0	1	1	1	H0609_026_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	26	0	1	1	1	H0609_026_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	26	0	1	1	1	H0609_026_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	26	0	1	1	1	H0609_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	26	0	1	1	1	H0609_026_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				841	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	27	0	1	1	1	H0609_027_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	27	0	1	1	1	H0609_027_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	27	0	1	1	1	H0609_027_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	27	0	1	1	1	H0609_027_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	27	0	1	1	1	H0609_027_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				824	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	28	0	1	1	1	H0609_028_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	28	0	1	1	1	H0609_028_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	28	0	1	1	1	H0609_028_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	28	0	1	1	1	H0609_028_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	28	0	1	1	1	H0609_028_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	28	0	1	1	1	H0609_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	28	0	1	1	1	H0609_028_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				940	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	31	0	1	1	1	H0609_031_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	31	0	1	1	1	H0609_031_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	31	0	1	1	1	H0609_031_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	31	0	1	1	1	H0609_031_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H0609	31	0	1	1	1	H0609_031_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	31	0	1	1	1	H0609_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	31	0	1	1	1	H0609_031_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				969	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	32	0	1	1	1	H0609_032_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	32	0	1	1	1	H0609_032_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	32	0	1	1	1	H0609_032_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	32	0	1	1	1	H0609_032_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	32	0	1	1	1	H0609_032_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	32	0	1	1	1	H0609_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	32	0	1	1	1	H0609_032_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				813	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	33	0	1	1	1	H0609_033_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	33	0	1	1	1	H0609_033_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	33	0	1	1	1	H0609_033_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	33	0	1	1	1	H0609_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	33	0	1	1	1	H0609_033_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				731	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	1	1	1	1	H0609_034_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	1	1	1	1	H0609_034_1	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	1	1	1	1	H0609_034_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	1	1	1	1	H0609_034_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	1	1	1	1	H0609_034_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				836	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	2	1	1	1	H0609_034_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	2	1	1	1	H0609_034_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	2	1	1	1	H0609_034_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	2	1	1	1	H0609_034_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	34	2	1	1	1	H0609_034_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				836	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	1	1	1	1	H0609_036_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	1	1	1	1	H0609_036_1	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	1	1	1	1	H0609_036_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	1	1	1	1	H0609_036_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	1	1	1	1	H0609_036_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				907	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	2	1	1	1	H0609_036_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	2	1	1	1	H0609_036_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	2	1	1	1	H0609_036_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	2	1	1	1	H0609_036_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	36	2	1	1	1	H0609_036_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				907	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	37	0	1	1	1	H0609_037_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	37	0	1	1	1	H0609_037_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	37	0	1	1	1	H0609_037_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	37	0	1	1	1	H0609_037_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	37	0	1	1	1	H0609_037_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	37	0	1	1	1	H0609_037_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	37	0	1	1	1	H0609_037_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				757	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	38	0	1	1	1	H0609_038_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		100	2	2						100	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	38	0	1	1	1	H0609_038_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		100	2	2						100	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	38	0	1	1	1	H0609_038_0	4	Generic	4	1	1	2	2	1		110	1		100	1				30		100	2	2						100	30		31								15		45					3		6													45						6				15				15			0.5	0.1				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	38	0	1	1	1	H0609_038_0	4	Generic	4	1	1	2	2	3		110	1		100	1				30		100	2	2						100	30		31								15		45					3		6													45						6				15				15			0.5	0.1				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0609	38	0	1	1	1	H0609_038_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		100	2	2						100	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	38	0	1	1	1	H0609_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		100	2	2						100	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	38	0	1	1	1	H0609_038_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		100	2	2						100	30		31											950	33		33				830	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	39	0	1	1	1	H0609_039_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		100	2	2						100	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	39	0	1	1	1	H0609_039_0	4	Generic	4	1	1	2	2	1		110	1		100	1				30		100	2	2						100	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	39	0	1	1	1	H0609_039_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		100	2	2						100	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	39	0	1	1	1	H0609_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		100	2	2						100	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0609	39	0	1	1	1	H0609_039_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		100	2	2						100	30		31											835	29		29				730	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0628	1	0	1	1	1	H0628_001_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	1	0	1	1	1	H0628_001_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0628	1	0	1	1	1	H0628_001_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	1	0	1	1	1	H0628_001_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0628	1	0	1	1	1	H0628_001_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	1	0	1	1	1	H0628_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	1	0	1	1	1	H0628_001_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											692.73	30						654.72	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	3	0	1	1	1	H0628_003_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	3	0	1	1	1	H0628_003_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0628	3	0	1	1	1	H0628_003_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	3	0	1	1	1	H0628_003_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0628	3	0	1	1	1	H0628_003_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	3	0	1	1	1	H0628_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	3	0	1	1	1	H0628_003_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											755.27	33						713.52	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	5	0	1	1	1	H0628_005_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	5	0	1	1	1	H0628_005_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0628	5	0	1	1	1	H0628_005_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	5	0	1	1	1	H0628_005_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0628	5	0	1	1	1	H0628_005_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	5	0	1	1	1	H0628_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0628	5	0	1	1	1	H0628_005_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											692.73	30						654.71	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H0630	13	0	1	1	1	H0630_013_0	11	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								19	38	57					4	8	12											19	38	57				0	0	0				19				19			0.63	0.13		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	13	0	1	1	1	H0630_013_0	11	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				5	5	5				20				20			0.66	0.33		0.66	0.16	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	13	0	1	1	1	H0630_013_0	11	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	100				47				47			1.56	1.33		1.56	1.33	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	13	0	1	1	1	H0630_013_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	245				100				100			3.33	3.16		3.33	3.16	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	13	0	1	1	1	H0630_013_0	11	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1505	28	28	28				1505	28	28	28										28	28	28				28	28	28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	13	0	1	1	1	H0630_013_0	11	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	15	0	1	1	1	H0630_015_0	11	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								19	38	57					4	8	12											19	38	57				0	0	0				19				19			0.63	0.13		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	15	0	1	1	1	H0630_015_0	11	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				0	0	0				20				20			0.66	0.33		0.66	0	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	15	0	1	1	1	H0630_015_0	11	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	100				47				47			1.56	1.33		1.56	1.33	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	15	0	1	1	1	H0630_015_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	245				100				100			3.33	3.16		3.33	3.16	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	15	0	1	1	1	H0630_015_0	11	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1730	29	29	29				1730	29	29	29										29	29	29				29	29	29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	15	0	1	1	1	H0630_015_0	11	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	16	0	1	1	1	H0630_016_0	11	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								19	38	57					3	6	9											19	38	57				0	0	0				19				19			0.63	0.1		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	16	0	1	1	1	H0630_016_0	11	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					8	16	24											20	40	60				0	0	0				20				20			0.66	0.26		0.66	0	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	16	0	1	1	1	H0630_016_0	11	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	100				47				47			1.56	1.33		1.56	1.33	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	16	0	1	1	1	H0630_016_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	245				100				100			3.33	3		3.33	3	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	16	0	1	1	1	H0630_016_0	11	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1555	29	29	29				1555	29	29	29										29	29	29				29	29	29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	16	0	1	1	1	H0630_016_0	11	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	17	0	1	1	1	H0630_017_0	13	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								19	38	57					4	8	12											19	38	57				0	0	0				19				19			0.63	0.13		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	17	0	1	1	1	H0630_017_0	13	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				0	0	0				20				20			0.66	0.33		0.66	0	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	17	0	1	1	1	H0630_017_0	13	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	100				47				47			1.56	1.33		1.56	1.33	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	17	0	1	1	1	H0630_017_0	13	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					93	186	279											100	200	300				93	186	245				100				100			3.33	3.1		3.33	3.1	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	17	0	1	1	1	H0630_017_0	13	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1637	28	28	28				1637	28	28	28										28	28	28				28	28	28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	17	0	1	1	1	H0630_017_0	13	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	20	0	1	1	1	H0630_020_0	11	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								19	38	57					4	8	12											19	38	57				0	0	0				19				19			0.63	0.13		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	20	0	1	1	1	H0630_020_0	11	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				0	0	0				20				20			0.66	0.33		0.66	0	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	20	0	1	1	1	H0630_020_0	11	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	100				47				47			1.56	1.33		1.56	1.33	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	20	0	1	1	1	H0630_020_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	245				100				100			3.33	3.16		3.33	3.16	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	20	0	1	1	1	H0630_020_0	11	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1609	28	28	28				1609	28	28	28										28	28	28				28	28	28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	20	0	1	1	1	H0630_020_0	11	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	21	0	1	1	1	H0630_021_0	11	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								19	38	57					4	8	12											19	38	57				0	0	0				19				19			0.63	0.13		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	21	0	1	1	1	H0630_021_0	11	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				0	0	0				20				20			0.66	0.33		0.66	0	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	21	0	1	1	1	H0630_021_0	11	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	100				47				47			1.56	1.33		1.56	1.33	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	21	0	1	1	1	H0630_021_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	245				100				100			3.33	3.16		3.33	3.16	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	21	0	1	1	1	H0630_021_0	11	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1774	29	29	29				1774	29	29	29										29	29	29				29	29	29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0630	21	0	1	1	1	H0630_021_0	11	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H0672	1	0	1	1	1	H0672_001_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	1	0	1	1	1	H0672_001_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	1	0	1	1	1	H0672_001_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	1	0	1	1	1	H0672_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	1	0	1	1	1	H0672_001_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											908.08	33						1017.17	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	2	0	1	1	1	H0672_002_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	2	0	1	1	1	H0672_002_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	2	0	1	1	1	H0672_002_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	2	0	1	1	1	H0672_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0672	2	0	1	1	1	H0672_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											908.08	33						1017.17	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	8	0	1	4	1	H0710_008_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	8	0	1	4	1	H0710_008_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	8	0	1	4	1	H0710_008_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	8	0	1	4	1	H0710_008_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	8	0	1	4	1	H0710_008_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				807	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	9	0	1	4	1	H0710_009_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	9	0	1	4	1	H0710_009_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	9	0	1	4	1	H0710_009_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	9	0	1	4	1	H0710_009_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	9	0	1	4	1	H0710_009_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				897	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	12	0	1	4	1	H0710_012_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	12	0	1	4	1	H0710_012_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	12	0	1	4	1	H0710_012_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	12	0	1	4	1	H0710_012_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	12	0	1	4	1	H0710_012_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				757	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	30	0	1	4	1	H0710_030_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	30	0	1	4	1	H0710_030_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	30	0	1	4	1	H0710_030_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	30	0	1	4	1	H0710_030_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	30	0	1	4	1	H0710_030_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				737	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	37	0	1	4	1	H0710_037_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	37	0	1	4	1	H0710_037_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	37	0	1	4	1	H0710_037_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	37	0	1	4	1	H0710_037_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	37	0	1	4	1	H0710_037_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				668	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	42	0	1	4	1	H0710_042_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	42	0	1	4	1	H0710_042_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	42	0	1	4	1	H0710_042_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	42	0	1	4	1	H0710_042_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	42	0	1	4	1	H0710_042_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				737	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	47	0	1	4	1	H0710_047_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	47	0	1	4	1	H0710_047_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	47	0	1	4	1	H0710_047_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	47	0	1	4	1	H0710_047_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	47	0	1	4	1	H0710_047_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				617	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	49	0	1	4	1	H0710_049_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	49	0	1	4	1	H0710_049_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	49	0	1	4	1	H0710_049_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	49	0	1	4	1	H0710_049_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	49	0	1	4	1	H0710_049_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				743	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	50	0	1	4	1	H0710_050_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	50	0	1	4	1	H0710_050_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	50	0	1	4	1	H0710_050_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	50	0	1	4	1	H0710_050_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0710	50	0	1	4	1	H0710_050_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				619	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	5	0	1	1	1	H0712_005_0	8	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	5	0	1	1	1	H0712_005_0	8	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	11		33																									11		33				11		0				11				11		0.37				0.37	0.37	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	5	0	1	1	1	H0712_005_0	8	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	5	0	1	1	1	H0712_005_0	8	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.51	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	5	0	1	1	1	H0712_005_0	8	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	19	0	1	1	1	H0712_019_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	19	0	1	1	1	H0712_019_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	19	0	1	1	1	H0712_019_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	19	0	1	1	1	H0712_019_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				93.73	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	19	0	1	1	1	H0712_019_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	20	0	1	2	1	H0712_020_0	8	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	6		18																									6		18				6		0				6				6		0.2				0.2	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	20	0	1	2	1	H0712_020_0	8	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	19		57																									19		57				19		0				19				19		0.63				0.63	0.63	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	20	0	1	2	1	H0712_020_0	8	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	20	0	1	2	1	H0712_020_0	8	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				96.09	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	20	0	1	2	1	H0712_020_0	8	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	22	0	1	1	1	H0712_022_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	22	0	1	1	1	H0712_022_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	22	0	1	1	1	H0712_022_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	22	0	1	1	1	H0712_022_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				88.6	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	22	0	1	1	1	H0712_022_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					30																										30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	23	0	1	1	1	H0712_023_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	23	0	1	1	1	H0712_023_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	23	0	1	1	1	H0712_023_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	23	0	1	1	1	H0712_023_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				94.45	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	23	0	1	1	1	H0712_023_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					30																										30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	25	0	1	1	1	H0712_025_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	25	0	1	1	1	H0712_025_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	25	0	1	1	1	H0712_025_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	25	0	1	1	1	H0712_025_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				94.64	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	25	0	1	1	1	H0712_025_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	28	0	1	1	1	H0712_028_0	8	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	28	0	1	1	1	H0712_028_0	8	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	28	0	1	1	1	H0712_028_0	8	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	28	0	1	1	1	H0712_028_0	8	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.65	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	28	0	1	1	1	H0712_028_0	8	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	29	0	1	1	1	H0712_029_0	8	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	29	0	1	1	1	H0712_029_0	8	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	29	0	1	1	1	H0712_029_0	8	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	29	0	1	1	1	H0712_029_0	8	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.65	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	29	0	1	1	1	H0712_029_0	8	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	30	0	1	1	1	H0712_030_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	30	0	1	1	1	H0712_030_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	30	0	1	1	1	H0712_030_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	30	0	1	1	1	H0712_030_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.49	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0712	30	0	1	1	1	H0712_030_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0724	1	0	1	1	1	H0724_001_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0724	1	0	1	1	1	H0724_001_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					9	18	27					9	18	27																14				14			0.47	0.3	0.3			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0724	1	0	1	1	1	H0724_001_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0724	1	0	1	1	1	H0724_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0724	1	0	1	1	1	H0724_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0724	1	0	1	1	1	H0724_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0755	30	0	1	1	1	H0755_030_0	7	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	30	0	1	1	1	H0755_030_0	7	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	30	0	1	1	1	H0755_030_0	7	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H0755	30	0	1	1	1	H0755_030_0	7	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	30	0	1	1	1	H0755_030_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	30	0	1	1	1	H0755_030_0	7	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				987	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	31	0	1	1	1	H0755_031_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	31	0	1	1	1	H0755_031_0	6	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	31	0	1	1	1	H0755_031_0	6	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H0755	31	0	1	1	1	H0755_031_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	31	0	1	1	1	H0755_031_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	31	0	1	1	1	H0755_031_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				865	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	33	0	1	1	1	H0755_033_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	33	0	1	1	1	H0755_033_0	6	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	33	0	1	1	1	H0755_033_0	6	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H0755	33	0	1	1	1	H0755_033_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	33	0	1	1	1	H0755_033_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	33	0	1	1	1	H0755_033_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				639	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	38	0	1	1	1	H0755_038_0	8	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	38	0	1	1	1	H0755_038_0	8	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	38	0	1	1	1	H0755_038_0	8	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	38	0	1	1	1	H0755_038_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	38	0	1	1	1	H0755_038_0	8	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				813	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	1	1	1	1	H0755_040_1	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	1	1	1	1	H0755_040_1	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	1	1	1	1	H0755_040_1	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	1	1	1	1	H0755_040_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	1	1	1	1	H0755_040_1	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				759	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	2	1	1	1	H0755_040_2	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	2	1	1	1	H0755_040_2	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	2	1	1	1	H0755_040_2	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	2	1	1	1	H0755_040_2	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	40	2	1	1	1	H0755_040_2	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				759	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	1	1	1	1	H0755_041_1	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	1	1	1	1	H0755_041_1	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	1	1	1	1	H0755_041_1	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	1	1	1	1	H0755_041_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	1	1	1	1	H0755_041_1	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				766	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	2	1	1	1	H0755_041_2	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	2	1	1	1	H0755_041_2	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	2	1	1	1	H0755_041_2	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	2	1	1	1	H0755_041_2	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	41	2	1	1	1	H0755_041_2	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				766	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	1	1	1	1	H0755_042_1	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	1	1	1	1	H0755_042_1	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	1	1	1	1	H0755_042_1	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	1	1	1	1	H0755_042_1	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	1	1	1	1	H0755_042_1	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				747	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	2	1	1	1	H0755_042_2	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	2	1	1	1	H0755_042_2	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	2	1	1	1	H0755_042_2	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	2	1	1	1	H0755_042_2	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0755	42	2	1	1	1	H0755_042_2	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				747	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0798	1	0	1	1	1	H0798_001_0	11	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0798	1	0	1	1	1	H0798_001_0	11	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0798	1	0	1	1	1	H0798_001_0	11	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		141							131																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0798	1	0	1	1	1	H0798_001_0	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											81.3	50		50				87.89	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0798	1	0	1	1	1	H0798_001_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0838	20	0	1	1	1	H0838_020_0	6	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	20	0	1	1	1	H0838_020_0	6	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				8.37	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	20	0	1	1	1	H0838_020_0	6	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				107.74	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	20	0	1	1	1	H0838_020_0	6	Non-Preferred Drug	4	10	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				36.13	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	20	0	1	1	1	H0838_020_0	6	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	20	0	1	1	1	H0838_020_0	6	Select Care Drugs	4	10	1	1	6	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	24	0	1	1	1	H0838_024_0	7	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	24	0	1	1	1	H0838_024_0	7	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				8.23	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	24	0	1	1	1	H0838_024_0	7	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				89.56	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	24	0	1	1	1	H0838_024_0	7	Non-Preferred Drug	4	10	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				45.84	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	24	0	1	1	1	H0838_024_0	7	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	24	0	1	1	1	H0838_024_0	7	Select Care Drugs	4	10	1	1	6	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	25	0	1	1	1	H0838_025_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	25	0	1	1	1	H0838_025_0	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	25	0	1	1	1	H0838_025_0	8	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	2			90				30		31	9		27																					18																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	25	0	1	1	1	H0838_025_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	47		141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	25	0	1	1	1	H0838_025_0	8	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	25	0	1	1	1	H0838_025_0	8	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	25	0	1	1	1	H0838_025_0	8	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	25	0	1	1	1	H0838_025_0	8	Select Care Drugs	4	10	1	2	6	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	28	0	1	1	1	H0838_028_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	28	0	1	1	1	H0838_028_0	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	28	0	1	1	1	H0838_028_0	8	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	2			90				30		31	9		27																					18																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	28	0	1	1	1	H0838_028_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	45		135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	28	0	1	1	1	H0838_028_0	8	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	90		270																					270																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	28	0	1	1	1	H0838_028_0	8	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	28	0	1	1	1	H0838_028_0	8	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	28	0	1	1	1	H0838_028_0	8	Select Care Drugs	4	10	1	2	6	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	29	0	1	1	1	H0838_029_0	6	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	29	0	1	1	1	H0838_029_0	6	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				7.97	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	29	0	1	1	1	H0838_029_0	6	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				101.01	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	29	0	1	1	1	H0838_029_0	6	Non-Preferred Drug	4	10	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				52.55	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	29	0	1	1	1	H0838_029_0	6	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	29	0	1	1	1	H0838_029_0	6	Select Care Drugs	4	10	1	1	6	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	32	0	1	1	1	H0838_032_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H0838	32	0	1	1	1	H0838_032_0	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H0838	32	0	1	1	1	H0838_032_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H0838	32	0	1	1	1	H0838_032_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	45		135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H0838	32	0	1	1	1	H0838_032_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	90		270																					270																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H0838	32	0	1	1	1	H0838_032_0	8	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H0838	32	0	1	1	1	H0838_032_0	8	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H0838	32	0	1	1	1	H0838_032_0	8	Select Care Drugs	4	10	1	2	6	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H0838	33	0	1	1	1	H0838_033_0	7	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	33	0	1	1	1	H0838_033_0	7	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				8.77	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	33	0	1	1	1	H0838_033_0	7	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				92.92	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	33	0	1	1	1	H0838_033_0	7	Non-Preferred Drug	4	10	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				44.63	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	33	0	1	1	1	H0838_033_0	7	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	33	0	1	1	1	H0838_033_0	7	Select Care Drugs	4	10	1	1	6	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	37	0	1	1	1	H0838_037_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	37	0	1	1	1	H0838_037_0	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	37	0	1	1	1	H0838_037_0	7	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	2			90				30		31	12		36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	37	0	1	1	1	H0838_037_0	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	47		141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	37	0	1	1	1	H0838_037_0	7	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	37	0	1	1	1	H0838_037_0	7	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	37	0	1	1	1	H0838_037_0	7	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	37	0	1	1	1	H0838_037_0	7	Select Care Drugs	4	10	1	2	6	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	39	1	1	1	1	H0838_039_1	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	1	1	1	1	H0838_039_1	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	39	1	1	1	1	H0838_039_1	8	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	2			90				30		31	12		36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	1	1	1	1	H0838_039_1	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	47		141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	1	1	1	1	H0838_039_1	8	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	90		270																					270																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	1	1	1	1	H0838_039_1	8	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	1	1	1	1	H0838_039_1	8	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	1	1	1	1	H0838_039_1	8	Select Care Drugs	4	10	1	2	6	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	39	2	1	1	1	H0838_039_2	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	2	1	1	1	H0838_039_2	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	39	2	1	1	1	H0838_039_2	8	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	2			90				30		31	12		36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	2	1	1	1	H0838_039_2	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	47		141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	2	1	1	1	H0838_039_2	8	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	90		270																					270																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	2	1	1	1	H0838_039_2	8	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	2	1	1	1	H0838_039_2	8	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	39	2	1	1	1	H0838_039_2	8	Select Care Drugs	4	10	1	2	6	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H0838	40	1	1	1	1	H0838_040_1	7	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	1	1	1	1	H0838_040_1	7	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				7.8	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	1	1	1	1	H0838_040_1	7	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				99.04	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	1	1	1	1	H0838_040_1	7	Non-Preferred Drug	4	10	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				54.39	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	1	1	1	1	H0838_040_1	7	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	1	1	1	1	H0838_040_1	7	Select Care Drugs	4	10	1	1	6	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	2	1	1	1	H0838_040_2	7	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	2	1	1	1	H0838_040_2	7	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				7.8	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	2	1	1	1	H0838_040_2	7	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				99.04	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	2	1	1	1	H0838_040_2	7	Non-Preferred Drug	4	10	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				54.39	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	2	1	1	1	H0838_040_2	7	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	40	2	1	1	1	H0838_040_2	7	Select Care Drugs	4	10	1	1	6	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	41	0	1	1	1	H0838_041_0	6	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	41	0	1	1	1	H0838_041_0	6	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				9.07	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	41	0	1	1	1	H0838_041_0	6	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				79.65	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	41	0	1	1	1	H0838_041_0	6	Non-Preferred Drug	4	10	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				45.64	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	41	0	1	1	1	H0838_041_0	6	Specialty Tier	4	10	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0838	41	0	1	1	1	H0838_041_0	6	Select Care Drugs	4	10	1	1	6	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0908	1	0	1	1	1	H0908_001_0	5	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0908	1	0	1	1	1	H0908_001_0	5	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0908	1	0	1	1	1	H0908_001_0	5	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0908	1	0	1	1	1	H0908_001_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0908	1	0	1	1	1	H0908_001_0	5	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0908	1	0	1	1	1	H0908_001_0	5	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H0913	2	0	1	2	1	H0913_002_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	2	0	1	2	1	H0913_002_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	2	0	1	2	1	H0913_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	2	0	1	2	1	H0913_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.01	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	2	0	1	2	1	H0913_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	13	0	1	1	1	H0913_013_0	5	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	13	0	1	1	1	H0913_013_0	5	Generic	2	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	13	0	1	1	1	H0913_013_0	5	Preferred Brand	2	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	13	0	1	1	1	H0913_013_0	5	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.98	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	13	0	1	1	1	H0913_013_0	5	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	15	0	1	1	1	H0913_015_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	15	0	1	1	1	H0913_015_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	15	0	1	1	1	H0913_015_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	15	0	1	1	1	H0913_015_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	15	0	1	1	1	H0913_015_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	17	0	1	1	1	H0913_017_0	5	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	17	0	1	1	1	H0913_017_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	17	0	1	1	1	H0913_017_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	17	0	1	1	1	H0913_017_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.3	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0913	17	0	1	1	1	H0913_017_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0927	1	0	1	48	5	H0927_001_0	5	Generic Drugs	4	11			1	1	110		1	100		1	30		90				1	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0927	1	0	1	48	5	H0927_001_0	5	Brand Drugs	4	11			2	1	110		1	100		1	30		90				1	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H0927	1	0	1	48	5	H0927_001_0	5	Non-Medicare OTC Drugs	4	11			3	1	110		1	100		1	30		90				1	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H0969	1	0	1	4	1	H0969_001_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	1	0	1	4	1	H0969_001_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	1	0	1	4	1	H0969_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	1	0	1	4	1	H0969_001_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.26	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	1	0	1	4	1	H0969_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	2	0	1	4	1	H0969_002_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	2	0	1	4	1	H0969_002_0	7	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H0969	2	0	1	4	1	H0969_002_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	2	0	1	4	1	H0969_002_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	2	0	1	4	1	H0969_002_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.19	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0969	2	0	1	4	1	H0969_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H0982	1	0	1	1	1	H0982_001_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	1	0	1	1	1	H0982_001_0	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	1	0	1	1	1	H0982_001_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	1	0	1	1	1	H0982_001_0	7	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	1	0	1	1	1	H0982_001_0	7	Preferred Brand	4	10	1	2	3	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	1	0	1	1	1	H0982_001_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1			1	30														30		31	35																																							35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	1	0	1	1	1	H0982_001_0	7	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				1851.04	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	1	0	1	1	1	H0982_001_0	7	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	2	0	1	1	1	H0982_002_0	6	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	2	0	1	1	1	H0982_002_0	6	Preferred Generic	4	1	1	1	1	3	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	2	0	1	1	1	H0982_002_0	6	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	2	0	1	1	1	H0982_002_0	6	Generic	4	1	1	1	2	3	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	2	0	1	1	1	H0982_002_0	6	Preferred Brand	4	10	1	1	3	1	10		1			1	30														30		31				104.16	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	2	0	1	1	1	H0982_002_0	6	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		31				92.52	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	2	0	1	1	1	H0982_002_0	6	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				806.48	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	2	0	1	1	1	H0982_002_0	6	Supplemental Brand and Generic Drugs	4	11	2	1	6	1	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	5	0	1	1	1	H0982_005_0	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	5	0	1	1	1	H0982_005_0	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	5	0	1	1	1	H0982_005_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	5	0	1	1	1	H0982_005_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	5	0	1	1	1	H0982_005_0	6	Preferred Brand	4	10	1	2	3	1	10		1			1	30														30		31	25																																							25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	5	0	1	1	1	H0982_005_0	6	Non-Preferred Brand	4	10	1	2	4	1	10		1			1	30														30		31	85																																							85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	5	0	1	1	1	H0982_005_0	6	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				1715.4	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	5	0	1	1	1	H0982_005_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	6	0	1	1	1	H0982_006_0	6	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	6	0	1	1	1	H0982_006_0	6	Preferred Generic	4	1	1	1	1	3	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	6	0	1	1	1	H0982_006_0	6	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	6	0	1	1	1	H0982_006_0	6	Generic	4	1	1	1	2	3	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	6	0	1	1	1	H0982_006_0	6	Preferred Brand	4	10	1	1	3	1	10		1			1	30														30		31				103.61	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	6	0	1	1	1	H0982_006_0	6	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		31				91.41	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	6	0	1	1	1	H0982_006_0	6	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				803.84	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	6	0	1	1	1	H0982_006_0	6	Supplemental Brand and Generic Drugs	4	11	2	1	6	1	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	7	0	1	1	1	H0982_007_0	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	7	0	1	1	1	H0982_007_0	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	7	0	1	1	1	H0982_007_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	7	0	1	1	1	H0982_007_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	7	0	1	1	1	H0982_007_0	6	Preferred Brand	4	10	1	2	3	1	10		1			1	30														30		31	20																																							20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	7	0	1	1	1	H0982_007_0	6	Non-Preferred Brand	4	10	1	2	4	1	10		1			1	30														30		31	85																																							85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	7	0	1	1	1	H0982_007_0	6	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				1548.21	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	7	0	1	1	1	H0982_007_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	8	0	1	1	1	H0982_008_0	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	8	0	1	1	1	H0982_008_0	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	8	0	1	1	1	H0982_008_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	8	0	1	1	1	H0982_008_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	8	0	1	1	1	H0982_008_0	6	Preferred Brand	4	10	1	2	3	1	10		1			1	30														30		31	20																																							20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	8	0	1	1	1	H0982_008_0	6	Non-Preferred Brand	4	10	1	2	4	1	10		1			1	30														30		31	97																																							97				97		3.23						3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	8	0	1	1	1	H0982_008_0	6	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				1625.97	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	8	0	1	1	1	H0982_008_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	9	0	1	1	1	H0982_009_0	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	9	0	1	1	1	H0982_009_0	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	9	0	1	1	1	H0982_009_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	9	0	1	1	1	H0982_009_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	9	0	1	1	1	H0982_009_0	6	Preferred Brand	4	10	1	2	3	1	10		1			1	30														30		31	25																																							25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	9	0	1	1	1	H0982_009_0	6	Non-Preferred Brand	4	10	1	2	4	1	10		1			1	30														30		31	85																																							85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	9	0	1	1	1	H0982_009_0	6	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				1716.52	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	9	0	1	1	1	H0982_009_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	10	0	1	1	1	H0982_010_0	6	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	10	0	1	1	1	H0982_010_0	6	Preferred Generic	4	1	1	1	1	3	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	10	0	1	1	1	H0982_010_0	6	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	10	0	1	1	1	H0982_010_0	6	Generic	4	1	1	1	2	3	110		1	100		1	30		90				2	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H0982	10	0	1	1	1	H0982_010_0	6	Preferred Brand	4	10	1	1	3	1	10		1			1	30														30		31				103.59	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	10	0	1	1	1	H0982_010_0	6	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		31				91.37	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	10	0	1	1	1	H0982_010_0	6	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				803.74	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H0982	10	0	1	1	1	H0982_010_0	6	Supplemental Brand and Generic Drugs	4	11	2	1	6	1	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H1016	1	0	1	1	1	H1016_001_0	10	Preferred Generic	4	11	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	1	0	1	1	1	H1016_001_0	10	Preferred Generic	4	11	3	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	1	0	1	1	1	H1016_001_0	10	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				10				0			0.33	0		0.33	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	1	0	1	1	1	H1016_001_0	10	Generic	4	11	3	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	1	0	1	1	1	H1016_001_0	10	Preferred Brand	4	11	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								35	70	87.5					25	50	62.5											35	70	105				25	50	62.5				35				25			1.17	0.83		1.17	0.83	0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	1	0	1	1	1	H1016_001_0	10	Non-Preferred Drug	4	11	3	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								85	170	212.5					70	140	175											85	170	255				70	140	175				85				70			2.83	2.33		2.83	2.33	2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	1	0	1	1	1	H1016_001_0	10	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											696.39	33						696.39	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	21	0	1	1	1	H1016_021_0	12	Preferred Generic	4	11	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	21	0	1	1	1	H1016_021_0	12	Preferred Generic	4	11	3	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	21	0	1	1	1	H1016_021_0	12	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				10				0			0.33	0		0.33	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	21	0	1	1	1	H1016_021_0	12	Generic	4	11	3	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				10				0			0.33	0		0.33	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	21	0	1	1	1	H1016_021_0	12	Preferred Brand	4	11	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								40	80	100					30	60	75											40	80	120				30	60	75				40				30			1.33	1		1.33	1	0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	21	0	1	1	1	H1016_021_0	12	Non-Preferred Drug	4	11	3	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	250					75	150	187.5											100	200	300				75	150	187.5				100				75			3.33	2.5		3.33	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	21	0	1	1	1	H1016_021_0	12	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											696.39	33						696.39	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	23	0	1	1	1	H1016_023_0	9	Preferred Generic	4	11	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	23	0	1	1	1	H1016_023_0	9	Preferred Generic	4	11	3	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	23	0	1	1	1	H1016_023_0	9	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				10				0			0.33	0		0.33	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	23	0	1	1	1	H1016_023_0	9	Generic	4	11	3	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				0				0			0.33	0		0.33	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	23	0	1	1	1	H1016_023_0	9	Preferred Brand	4	11	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								25	50	62.5					15	30	37.5											25	50	75				15	30	37.5				25				15			0.83	0.5		0.83	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	23	0	1	1	1	H1016_023_0	9	Non-Preferred Drug	4	11	3	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								85	170	212.5					65	130	162.5											85	170	255				65	130	162.5				85				65			2.83	2.17		2.83	2.17	2.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	23	0	1	1	1	H1016_023_0	9	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											696.39	33						696.39	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	24	0	1	1	1	H1016_024_0	9	Preferred Generic	4	11	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	24	0	1	1	1	H1016_024_0	9	Preferred Generic	4	11	3	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	24	0	1	1	1	H1016_024_0	9	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				10				0			0.33	0		0.33	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	24	0	1	1	1	H1016_024_0	9	Generic	4	11	3	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	25					0	0	0											10	20	30				0	0	0				10				0			0.33	0		0.33	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1016	24	0	1	1	1	H1016_024_0	9	Preferred Brand	4	11	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								30	60	75					20	40	50											30	60	90				20	40	50				30				20			1	0.67		1	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	24	0	1	1	1	H1016_024_0	9	Non-Preferred Drug	4	11	3	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	250					75	150	187.5											100	200	300				75	150	187.5				100				75			3.33	2.5		3.33	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1016	24	0	1	1	1	H1016_024_0	9	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											696.39	33						696.39	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	1	0	1	1	1	H1019_001_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	1	0	1	1	1	H1019_001_0	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	1	0	1	1	1	H1019_001_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	1	0	1	1	1	H1019_001_0	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	1	0	1	1	1	H1019_001_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					20		60											47		141				20		50				47				47			1.57	0.67		1.57	0.67	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	1	0	1	1	1	H1019_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	1	0	1	1	1	H1019_001_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	6	0	1	1	1	H1019_006_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	6	0	1	1	1	H1019_006_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	6	0	1	1	1	H1019_006_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	6	0	1	1	1	H1019_006_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	6	0	1	1	1	H1019_006_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	6	0	1	1	1	H1019_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								36		108					35		105											36		108				35		95				36				36			1.2	1.17		1.2	1.17	1.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	6	0	1	1	1	H1019_006_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	23	0	1	1	1	H1019_023_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	23	0	1	1	1	H1019_023_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	23	0	1	1	1	H1019_023_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	23	0	1	1	1	H1019_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	23	0	1	1	1	H1019_023_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	24	0	1	1	1	H1019_024_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	24	0	1	1	1	H1019_024_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	24	0	1	1	1	H1019_024_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	24	0	1	1	1	H1019_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	24	0	1	1	1	H1019_024_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	26	0	1	1	1	H1019_026_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	26	0	1	1	1	H1019_026_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	26	0	1	1	1	H1019_026_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	26	0	1	1	1	H1019_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	26	0	1	1	1	H1019_026_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	28	0	1	1	1	H1019_028_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	28	0	1	1	1	H1019_028_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	28	0	1	1	1	H1019_028_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	28	0	1	1	1	H1019_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	28	0	1	1	1	H1019_028_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	43	0	1	1	1	H1019_043_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	43	0	1	1	1	H1019_043_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	43	0	1	1	1	H1019_043_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					30		90											47		141				30		80				47				47			1.57	1		1.57	1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	43	0	1	1	1	H1019_043_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	43	0	1	1	1	H1019_043_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	57	0	1	1	1	H1019_057_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	57	0	1	1	1	H1019_057_0	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	57	0	1	1	1	H1019_057_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	57	0	1	1	1	H1019_057_0	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	57	0	1	1	1	H1019_057_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					30		90											47		141				30		80				47				47			1.57	1		1.57	1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	57	0	1	1	1	H1019_057_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	57	0	1	1	1	H1019_057_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	65	0	1	1	1	H1019_065_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	65	0	1	1	1	H1019_065_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								12		36					0		0											12		36				0		0				12				12			0.4	0		0.4	0	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	65	0	1	1	1	H1019_065_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	65	0	1	1	1	H1019_065_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	65	0	1	1	1	H1019_065_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	69	0	1	1	1	H1019_069_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	69	0	1	1	1	H1019_069_0	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	69	0	1	1	1	H1019_069_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	69	0	1	1	1	H1019_069_0	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	69	0	1	1	1	H1019_069_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	69	0	1	1	1	H1019_069_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	69	0	1	1	1	H1019_069_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	73	0	1	1	1	H1019_073_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	73	0	1	1	1	H1019_073_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	73	0	1	1	1	H1019_073_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	73	0	1	1	1	H1019_073_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	73	0	1	1	1	H1019_073_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	76	0	1	1	1	H1019_076_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	76	0	1	1	1	H1019_076_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	76	0	1	1	1	H1019_076_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	76	0	1	1	1	H1019_076_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	76	0	1	1	1	H1019_076_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	77	0	1	1	1	H1019_077_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	77	0	1	1	1	H1019_077_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	77	0	1	1	1	H1019_077_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	77	0	1	1	1	H1019_077_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	77	0	1	1	1	H1019_077_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	79	0	1	1	1	H1019_079_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	79	0	1	1	1	H1019_079_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					3		9											20		60				3		0				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	79	0	1	1	1	H1019_079_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	79	0	1	1	1	H1019_079_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	79	0	1	1	1	H1019_079_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	81	0	1	1	1	H1019_081_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	81	0	1	1	1	H1019_081_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	81	0	1	1	1	H1019_081_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	81	0	1	1	1	H1019_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	81	0	1	1	1	H1019_081_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	83	0	1	1	1	H1019_083_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	83	0	1	1	1	H1019_083_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	83	0	1	1	1	H1019_083_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	83	0	1	1	1	H1019_083_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	83	0	1	1	1	H1019_083_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	85	0	1	1	1	H1019_085_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	85	0	1	1	1	H1019_085_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	85	0	1	1	1	H1019_085_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	85	0	1	1	1	H1019_085_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	85	0	1	1	1	H1019_085_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	89	0	1	1	1	H1019_089_0	5	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	89	0	1	1	1	H1019_089_0	5	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	89	0	1	1	1	H1019_089_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	89	0	1	1	1	H1019_089_0	5	Generic	4	11	1	1	2	3		110	1		110	1				30		90	2	2				30		90	30		31											6	15		15				0	0		0										15		15				0		0			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	89	0	1	1	1	H1019_089_0	5	Preferred Brand	4	11	1	1	3	1		110	1		110	1				30		90	2	2				30		90	30		31											43	25		25				42	24		24										25		25				24		24			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	89	0	1	1	1	H1019_089_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											225	25		25				32	24		24										25		25				24		24			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	89	0	1	1	1	H1019_089_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	90	0	1	1	1	H1019_090_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	90	0	1	1	1	H1019_090_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	90	0	1	1	1	H1019_090_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	90	0	1	1	1	H1019_090_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	90	0	1	1	1	H1019_090_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	91	0	1	1	1	H1019_091_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	91	0	1	1	1	H1019_091_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	91	0	1	1	1	H1019_091_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	91	0	1	1	1	H1019_091_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	91	0	1	1	1	H1019_091_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	92	0	1	1	1	H1019_092_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	92	0	1	1	1	H1019_092_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	92	0	1	1	1	H1019_092_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					35		105											47		141				35		95				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	92	0	1	1	1	H1019_092_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	92	0	1	1	1	H1019_092_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	94	0	1	1	1	H1019_094_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	94	0	1	1	1	H1019_094_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	94	0	1	1	1	H1019_094_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	94	0	1	1	1	H1019_094_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	94	0	1	1	1	H1019_094_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	98	0	1	1	1	H1019_098_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	98	0	1	1	1	H1019_098_0	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	98	0	1	1	1	H1019_098_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	98	0	1	1	1	H1019_098_0	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	98	0	1	1	1	H1019_098_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		80				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	98	0	1	1	1	H1019_098_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	98	0	1	1	1	H1019_098_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	99	0	1	1	1	H1019_099_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	99	0	1	1	1	H1019_099_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	99	0	1	1	1	H1019_099_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		90				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	99	0	1	1	1	H1019_099_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	99	0	1	1	1	H1019_099_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	100	0	1	1	1	H1019_100_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	100	0	1	1	1	H1019_100_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	100	0	1	1	1	H1019_100_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	100	0	1	1	1	H1019_100_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	100	0	1	1	1	H1019_100_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	101	0	1	1	1	H1019_101_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	101	0	1	1	1	H1019_101_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	101	0	1	1	1	H1019_101_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	101	0	1	1	1	H1019_101_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	101	0	1	1	1	H1019_101_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	102	0	1	1	1	H1019_102_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	102	0	1	1	1	H1019_102_0	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	102	0	1	1	1	H1019_102_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	102	0	1	1	1	H1019_102_0	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	102	0	1	1	1	H1019_102_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					35		105											47		141				35		70				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	102	0	1	1	1	H1019_102_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	102	0	1	1	1	H1019_102_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	1	1	1	1	H1019_103_1	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	1	1	1	1	H1019_103_1	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	103	1	1	1	1	H1019_103_1	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	1	1	1	1	H1019_103_1	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	103	1	1	1	1	H1019_103_1	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					10		30											47		141				10		20				47				47			1.57	0.33		1.57	0.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	1	1	1	1	H1019_103_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					55		165											100		300				55		155				100				100			3.33	1.83		3.33	1.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	1	1	1	1	H1019_103_1	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	2	1	1	1	H1019_103_2	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	2	1	1	1	H1019_103_2	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1019	103	2	1	1	1	H1019_103_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	2	1	1	1	H1019_103_2	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1019	103	2	1	1	1	H1019_103_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					10		30											47		141				10		20				47				47			1.57	0.33		1.57	0.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	2	1	1	1	H1019_103_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					55		165											100		300				55		155				100				100			3.33	1.83		3.33	1.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	103	2	1	1	1	H1019_103_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	1	1	1	1	H1019_104_1	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	1	1	1	1	H1019_104_1	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	1	1	1	1	H1019_104_1	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					35		105											47		141				35		95				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	1	1	1	1	H1019_104_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					60		180											100		300				60		170				100				100			3.33	2		3.33	2	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	1	1	1	1	H1019_104_1	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	2	1	1	1	H1019_104_2	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	2	1	1	1	H1019_104_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	2	1	1	1	H1019_104_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					35		105											47		141				35		95				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	2	1	1	1	H1019_104_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					60		180											100		300				60		170				100				100			3.33	2		3.33	2	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1019	104	2	1	1	1	H1019_104_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	32	0	1	1	1	H1032_032_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	32	0	1	1	1	H1032_032_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	32	0	1	1	1	H1032_032_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	32	0	1	1	1	H1032_032_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	25		75																									25		75				25		50				25				25		0.83				0.83	0.83	0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	32	0	1	1	1	H1032_032_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	32	0	1	1	1	H1032_032_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	40	0	1	1	1	H1032_040_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	40	0	1	1	1	H1032_040_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	40	0	1	1	1	H1032_040_0	5	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	40	0	1	1	1	H1032_040_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	25		75																									25		75				25		50				25				25		0.83				0.83	0.83	0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	40	0	1	1	1	H1032_040_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	50		150																									50		150				50		100				50				50		1.67				1.67	1.67	1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	40	0	1	1	1	H1032_040_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	61	0	1	1	1	H1032_061_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	61	0	1	1	1	H1032_061_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	61	0	1	1	1	H1032_061_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	61	0	1	1	1	H1032_061_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.96	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	61	0	1	1	1	H1032_061_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	73	0	1	1	1	H1032_073_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	73	0	1	1	1	H1032_073_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	73	0	1	1	1	H1032_073_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	73	0	1	1	1	H1032_073_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	73	0	1	1	1	H1032_073_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.6	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	73	0	1	1	1	H1032_073_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	124	0	1	1	1	H1032_124_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	124	0	1	1	1	H1032_124_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	124	0	1	1	1	H1032_124_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	124	0	1	1	1	H1032_124_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.49	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	124	0	1	1	1	H1032_124_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	133	0	1	2	1	H1032_133_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	133	0	1	2	1	H1032_133_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	133	0	1	2	1	H1032_133_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	133	0	1	2	1	H1032_133_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	133	0	1	2	1	H1032_133_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				79.41	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	133	0	1	2	1	H1032_133_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	170	0	1	1	1	H1032_170_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	170	0	1	1	1	H1032_170_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	170	0	1	1	1	H1032_170_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	170	0	1	1	1	H1032_170_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				86.33	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	170	0	1	1	1	H1032_170_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	174	0	1	2	1	H1032_174_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	174	0	1	2	1	H1032_174_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	174	0	1	2	1	H1032_174_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	174	0	1	2	1	H1032_174_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		30				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	174	0	1	2	1	H1032_174_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	174	0	1	2	1	H1032_174_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	175	0	1	1	1	H1032_175_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	175	0	1	1	1	H1032_175_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	175	0	1	1	1	H1032_175_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	175	0	1	1	1	H1032_175_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				96.57	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	175	0	1	1	1	H1032_175_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	176	0	1	1	1	H1032_176_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	176	0	1	1	1	H1032_176_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	176	0	1	1	1	H1032_176_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	176	0	1	1	1	H1032_176_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				90.2	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	176	0	1	1	1	H1032_176_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	182	0	1	1	1	H1032_182_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	182	0	1	1	1	H1032_182_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	182	0	1	1	1	H1032_182_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	182	0	1	1	1	H1032_182_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.24	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	182	0	1	1	1	H1032_182_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	184	0	1	1	1	H1032_184_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	184	0	1	1	1	H1032_184_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	184	0	1	1	1	H1032_184_0	5	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	184	0	1	1	1	H1032_184_0	5	Generic	4	11	3	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1032	184	0	1	1	1	H1032_184_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	184	0	1	1	1	H1032_184_0	5	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	184	0	1	1	1	H1032_184_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	184	0	1	1	1	H1032_184_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	186	0	1	1	1	H1032_186_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	186	0	1	1	1	H1032_186_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	186	0	1	1	1	H1032_186_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	186	0	1	1	1	H1032_186_0	5	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	186	0	1	1	1	H1032_186_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	186	0	1	1	1	H1032_186_0	5	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	186	0	1	1	1	H1032_186_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	50		150																									50		150				50		100				50				50		1.67				1.67	1.67	1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	186	0	1	1	1	H1032_186_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	189	0	1	1	1	H1032_189_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	189	0	1	1	1	H1032_189_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	189	0	1	1	1	H1032_189_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	189	0	1	1	1	H1032_189_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	189	0	1	1	1	H1032_189_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				81.62	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	189	0	1	1	1	H1032_189_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	190	0	1	1	1	H1032_190_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	190	0	1	1	1	H1032_190_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	190	0	1	1	1	H1032_190_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	190	0	1	1	1	H1032_190_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	190	0	1	1	1	H1032_190_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				84.38	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	190	0	1	1	1	H1032_190_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	191	0	1	1	1	H1032_191_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	191	0	1	1	1	H1032_191_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	191	0	1	1	1	H1032_191_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	191	0	1	1	1	H1032_191_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	191	0	1	1	1	H1032_191_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	191	0	1	1	1	H1032_191_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	192	0	1	1	1	H1032_192_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	192	0	1	1	1	H1032_192_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	192	0	1	1	1	H1032_192_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	192	0	1	1	1	H1032_192_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	192	0	1	1	1	H1032_192_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.99	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	192	0	1	1	1	H1032_192_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	193	0	1	1	1	H1032_193_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	193	0	1	1	1	H1032_193_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	193	0	1	1	1	H1032_193_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	193	0	1	1	1	H1032_193_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	193	0	1	1	1	H1032_193_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		270																									90		270				90		180				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	193	0	1	1	1	H1032_193_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	194	0	1	1	1	H1032_194_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	194	0	1	1	1	H1032_194_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	194	0	1	1	1	H1032_194_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	194	0	1	1	1	H1032_194_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	194	0	1	1	1	H1032_194_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	194	0	1	1	1	H1032_194_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	195	0	1	1	1	H1032_195_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	195	0	1	1	1	H1032_195_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	195	0	1	1	1	H1032_195_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	195	0	1	1	1	H1032_195_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	195	0	1	1	1	H1032_195_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		270																									90		270				90		180				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	195	0	1	1	1	H1032_195_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	196	0	1	1	1	H1032_196_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	196	0	1	1	1	H1032_196_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	196	0	1	1	1	H1032_196_0	4	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	196	0	1	1	1	H1032_196_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	196	0	1	1	1	H1032_196_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	196	0	1	1	1	H1032_196_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	197	0	1	1	1	H1032_197_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	197	0	1	1	1	H1032_197_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	197	0	1	1	1	H1032_197_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	197	0	1	1	1	H1032_197_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.39	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	197	0	1	1	1	H1032_197_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	198	0	1	1	1	H1032_198_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	198	0	1	1	1	H1032_198_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	198	0	1	1	1	H1032_198_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	198	0	1	1	1	H1032_198_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	198	0	1	1	1	H1032_198_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		270																									90		270				90		180				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	198	0	1	1	1	H1032_198_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	199	0	1	1	1	H1032_199_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	199	0	1	1	1	H1032_199_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	199	0	1	1	1	H1032_199_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	199	0	1	1	1	H1032_199_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	199	0	1	1	1	H1032_199_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	199	0	1	1	1	H1032_199_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	200	0	1	1	1	H1032_200_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	200	0	1	1	1	H1032_200_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	200	0	1	1	1	H1032_200_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	200	0	1	1	1	H1032_200_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	200	0	1	1	1	H1032_200_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	80		240																									80		240				80		160				80				80		2.67				2.67	2.67	2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	200	0	1	1	1	H1032_200_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	201	0	1	1	1	H1032_201_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	201	0	1	1	1	H1032_201_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	201	0	1	1	1	H1032_201_0	4	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	201	0	1	1	1	H1032_201_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		30				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	201	0	1	1	1	H1032_201_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	201	0	1	1	1	H1032_201_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	202	0	1	1	1	H1032_202_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	202	0	1	1	1	H1032_202_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	202	0	1	1	1	H1032_202_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	202	0	1	1	1	H1032_202_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.39	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	202	0	1	1	1	H1032_202_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	203	0	1	1	1	H1032_203_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	203	0	1	1	1	H1032_203_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	203	0	1	1	1	H1032_203_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	203	0	1	1	1	H1032_203_0	4	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	203	0	1	1	1	H1032_203_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	203	0	1	1	1	H1032_203_0	4	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	203	0	1	1	1	H1032_203_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	80		240																									80		240				80		160				80				80		2.67				2.67	2.67	2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	203	0	1	1	1	H1032_203_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	204	0	1	1	1	H1032_204_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	204	0	1	1	1	H1032_204_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	204	0	1	1	1	H1032_204_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	204	0	1	1	1	H1032_204_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	204	0	1	1	1	H1032_204_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				81.62	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	204	0	1	1	1	H1032_204_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	205	0	1	1	1	H1032_205_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	205	0	1	1	1	H1032_205_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	205	0	1	1	1	H1032_205_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	205	0	1	1	1	H1032_205_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	205	0	1	1	1	H1032_205_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				82.57	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	205	0	1	1	1	H1032_205_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	206	0	1	1	1	H1032_206_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	206	0	1	1	1	H1032_206_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	206	0	1	1	1	H1032_206_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	206	0	1	1	1	H1032_206_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	206	0	1	1	1	H1032_206_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	209	0	1	1	1	H1032_209_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	209	0	1	1	1	H1032_209_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	209	0	1	1	1	H1032_209_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	209	0	1	1	1	H1032_209_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	209	0	1	1	1	H1032_209_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				81.6	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	209	0	1	1	1	H1032_209_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	210	0	1	1	1	H1032_210_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	210	0	1	1	1	H1032_210_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	210	0	1	1	1	H1032_210_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	210	0	1	1	1	H1032_210_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	210	0	1	1	1	H1032_210_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		270																									90		270				90		180				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	210	0	1	1	1	H1032_210_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	211	0	1	1	1	H1032_211_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	211	0	1	1	1	H1032_211_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	211	0	1	1	1	H1032_211_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	211	0	1	1	1	H1032_211_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	211	0	1	1	1	H1032_211_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	211	0	1	1	1	H1032_211_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	212	0	1	1	1	H1032_212_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	212	0	1	1	1	H1032_212_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	212	0	1	1	1	H1032_212_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	212	0	1	1	1	H1032_212_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	212	0	1	1	1	H1032_212_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	95		285																									95		285				95		190				95				95		3.17				3.17	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	212	0	1	1	1	H1032_212_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	213	0	1	1	1	H1032_213_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	213	0	1	1	1	H1032_213_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	213	0	1	1	1	H1032_213_0	4	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	213	0	1	1	1	H1032_213_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	213	0	1	1	1	H1032_213_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	213	0	1	1	1	H1032_213_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	214	0	1	1	1	H1032_214_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	214	0	1	1	1	H1032_214_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	214	0	1	1	1	H1032_214_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	214	0	1	1	1	H1032_214_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	214	0	1	1	1	H1032_214_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	215	0	1	1	1	H1032_215_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	215	0	1	1	1	H1032_215_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	215	0	1	1	1	H1032_215_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	215	0	1	1	1	H1032_215_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	215	0	1	1	1	H1032_215_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	95		285																									95		285				95		190				95				95		3.17				3.17	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	215	0	1	1	1	H1032_215_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	216	0	1	1	1	H1032_216_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	216	0	1	1	1	H1032_216_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	216	0	1	1	1	H1032_216_0	4	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	216	0	1	1	1	H1032_216_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		30				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	216	0	1	1	1	H1032_216_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	216	0	1	1	1	H1032_216_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	217	0	1	1	1	H1032_217_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	217	0	1	1	1	H1032_217_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	217	0	1	1	1	H1032_217_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	217	0	1	1	1	H1032_217_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	217	0	1	1	1	H1032_217_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	218	0	1	1	1	H1032_218_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	218	0	1	1	1	H1032_218_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	218	0	1	1	1	H1032_218_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	218	0	1	1	1	H1032_218_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	218	0	1	1	1	H1032_218_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	218	0	1	1	1	H1032_218_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	219	0	1	1	1	H1032_219_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	219	0	1	1	1	H1032_219_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	219	0	1	1	1	H1032_219_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	219	0	1	1	1	H1032_219_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	219	0	1	1	1	H1032_219_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	219	0	1	1	1	H1032_219_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	220	0	1	1	1	H1032_220_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	220	0	1	1	1	H1032_220_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	220	0	1	1	1	H1032_220_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	220	0	1	1	1	H1032_220_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	220	0	1	1	1	H1032_220_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				63.8	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	220	0	1	1	1	H1032_220_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	221	0	1	1	1	H1032_221_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	221	0	1	1	1	H1032_221_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	221	0	1	1	1	H1032_221_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	221	0	1	1	1	H1032_221_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	221	0	1	1	1	H1032_221_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				63.8	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	221	0	1	1	1	H1032_221_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	1	1	2	1	H1032_222_1	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	1	1	2	1	H1032_222_1	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	222	1	1	2	1	H1032_222_1	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	1	1	2	1	H1032_222_1	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	1	1	2	1	H1032_222_1	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	1	1	2	1	H1032_222_1	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	2	1	2	1	H1032_222_2	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	2	1	2	1	H1032_222_2	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	222	2	1	2	1	H1032_222_2	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	2	1	2	1	H1032_222_2	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	2	1	2	1	H1032_222_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	2	1	2	1	H1032_222_2	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	3	1	2	1	H1032_222_3	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	3	1	2	1	H1032_222_3	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	222	3	1	2	1	H1032_222_3	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	3	1	2	1	H1032_222_3	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	3	1	2	1	H1032_222_3	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	3	1	2	1	H1032_222_3	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	4	1	2	1	H1032_222_4	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	4	1	2	1	H1032_222_4	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	222	4	1	2	1	H1032_222_4	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	4	1	2	1	H1032_222_4	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	4	1	2	1	H1032_222_4	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	222	4	1	2	1	H1032_222_4	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	1	1	1	1	H1032_223_1	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	1	1	1	1	H1032_223_1	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	223	1	1	1	1	H1032_223_1	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	1	1	1	1	H1032_223_1	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	1	1	1	1	H1032_223_1	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	1	1	1	1	H1032_223_1	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	2	1	1	1	H1032_223_2	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	2	1	1	1	H1032_223_2	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	223	2	1	1	1	H1032_223_2	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	2	1	1	1	H1032_223_2	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	2	1	1	1	H1032_223_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	2	1	1	1	H1032_223_2	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	3	1	1	1	H1032_223_3	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	3	1	1	1	H1032_223_3	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	223	3	1	1	1	H1032_223_3	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	3	1	1	1	H1032_223_3	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	3	1	1	1	H1032_223_3	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	3	1	1	1	H1032_223_3	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	4	1	1	1	H1032_223_4	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	4	1	1	1	H1032_223_4	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	223	4	1	1	1	H1032_223_4	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	4	1	1	1	H1032_223_4	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	4	1	1	1	H1032_223_4	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	4	1	1	1	H1032_223_4	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	5	1	1	1	H1032_223_5	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	5	1	1	1	H1032_223_5	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	223	5	1	1	1	H1032_223_5	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	5	1	1	1	H1032_223_5	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	5	1	1	1	H1032_223_5	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	223	5	1	1	1	H1032_223_5	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	224	0	1	1	1	H1032_224_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	224	0	1	1	1	H1032_224_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	224	0	1	1	1	H1032_224_0	4	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	224	0	1	1	1	H1032_224_0	4	Generic	4	11	3	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1032	224	0	1	1	1	H1032_224_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	224	0	1	1	1	H1032_224_0	4	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	224	0	1	1	1	H1032_224_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	224	0	1	1	1	H1032_224_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	225	0	1	1	1	H1032_225_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	225	0	1	1	1	H1032_225_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	225	0	1	1	1	H1032_225_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	225	0	1	1	1	H1032_225_0	4	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	225	0	1	1	1	H1032_225_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	225	0	1	1	1	H1032_225_0	4	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	225	0	1	1	1	H1032_225_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	225	0	1	1	1	H1032_225_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	226	0	1	1	1	H1032_226_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	226	0	1	1	1	H1032_226_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	226	0	1	1	1	H1032_226_0	4	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	226	0	1	1	1	H1032_226_0	4	Generic	4	11	3	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1032	226	0	1	1	1	H1032_226_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	226	0	1	1	1	H1032_226_0	4	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	226	0	1	1	1	H1032_226_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	75		225																									75		225				75		150				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	226	0	1	1	1	H1032_226_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	227	0	1	1	1	H1032_227_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	227	0	1	1	1	H1032_227_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	227	0	1	1	1	H1032_227_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	227	0	1	1	1	H1032_227_0	4	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	227	0	1	1	1	H1032_227_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	227	0	1	1	1	H1032_227_0	4	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	227	0	1	1	1	H1032_227_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	80		240																									80		240				80		160				80				80		2.67				2.67	2.67	2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	227	0	1	1	1	H1032_227_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	228	0	1	1	1	H1032_228_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	228	0	1	1	1	H1032_228_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	228	0	1	1	1	H1032_228_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	228	0	1	1	1	H1032_228_0	4	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1032	228	0	1	1	1	H1032_228_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	228	0	1	1	1	H1032_228_0	4	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1032	228	0	1	1	1	H1032_228_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	80		240																									80		240				80		160				80				80		2.67				2.67	2.67	2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1032	228	0	1	1	1	H1032_228_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1035	2	0	1	2	1	H1035_002_0	4	Preferred Generic	4	1	1	2	1	1		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	2	0	1	2	1	H1035_002_0	4	Preferred Generic	4	1	1	2	1	3		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	2	0	1	2	1	H1035_002_0	4	Generic	4	1	1	2	2	1		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					3	6	9						4	6																20				20			0.65	0.1				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	2	0	1	2	1	H1035_002_0	4	Generic	4	1	1	2	2	3		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					3	6	9						4	6																20				20			0.65	0.1				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	2	0	1	2	1	H1035_002_0	4	Preferred Brand	4	10	1	2	3	1		111	1	101		1				31	62	93	2	1		62	93				31		31								47	94	141					42	84	126						82	123																47				47			1.52	1.35				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	2	0	1	2	1	H1035_002_0	4	Non-Preferred Brand	4	10	1	2	4	1		111	1	101		1				31	62	93	2	1		62	93				31		31								100	200	300					92	184	276						182	273																100				100			3.23	2.97				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	2	0	1	2	1	H1035_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1			1				31											31		31											697.78	33						437.25	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	6	0	1	1	1	H1035_006_0	4	Preferred Generic	4	1	1	2	1	1		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	6	0	1	1	1	H1035_006_0	4	Generic	4	1	1	2	2	1		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					7	14	21						12	18																20				20			0.65	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	6	0	1	1	1	H1035_006_0	4	Preferred Brand	4	10	1	2	3	1		111	1	101		1				31	62	93	2	1		62	93				31		31								47	94	141					44	88	132						86	129																47				47			1.52	1.42				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	6	0	1	1	1	H1035_006_0	4	Non-Preferred Brand	4	10	1	2	4	1		111	1	101		1				31	62	93	2	1		62	93				31		31								100	200	300					95	190	285						188	282																100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	6	0	1	1	1	H1035_006_0	4	Specialty Tier	4	11	1	1	5	1		10	1			1				31											31		31											712.12	26						306.62	26																							26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	11	0	1	1	1	H1035_011_0	6	Preferred Generic	4	1	1	2	1	1		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	11	0	1	1	1	H1035_011_0	6	Preferred Generic	4	1	1	2	1	3		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	11	0	1	1	1	H1035_011_0	6	Generic	4	1	1	2	2	1		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					7	14	21						12	18																20				20			0.65	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	11	0	1	1	1	H1035_011_0	6	Generic	4	1	1	2	2	3		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					7	14	21						12	18																20				20			0.65	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	11	0	1	1	1	H1035_011_0	6	Preferred Brand	4	10	1	2	3	1		111	1	101		1				31	62	93	2	1		62	93				31		31								47	94	141					45	90	135						88	132																47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	11	0	1	1	1	H1035_011_0	6	Non-Preferred Brand	4	10	1	2	4	1		111	1	101		1				31	62	93	2	1		62	93				31		31								100	200	300					98	196	294						194	291																100				100			3.23	3.16				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	11	0	1	1	1	H1035_011_0	6	Specialty Tier	4	11	1	1	5	1		10	1			1				31											31		31											938.83	33						488.94	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	14	0	1	1	1	H1035_014_0	5	Preferred Generic	4	1	1	2	1	1		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					4	8	12						6	9																17				17			0.55	0.13				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	14	0	1	1	1	H1035_014_0	5	Generic	4	1	1	2	2	1		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					10	20	30						18	27																20				20			0.65	0.32				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	14	0	1	1	1	H1035_014_0	5	Preferred Brand	4	10	1	2	3	1		111	1	101		1				31	62	93	2	1		62	93				31		31								47	94	141					45	90	135						88	132																47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	14	0	1	1	1	H1035_014_0	5	Non-Preferred Brand	4	10	1	2	4	1		111	1	101		1				31	62	93	2	1		62	93				31		31								100	200	300					98	196	294						194	291																100				100			3.23	3.16				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	14	0	1	1	1	H1035_014_0	5	Specialty Tier	4	11	1	1	5	1		10	1			1				31											31		31											667.8	25						284.48	25																							25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	16	0	1	1	1	H1035_016_0	4	Preferred Generic	4	1	1	2	1	1		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	16	0	1	1	1	H1035_016_0	4	Preferred Generic	4	1	1	2	1	3		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	16	0	1	1	1	H1035_016_0	4	Generic	4	1	1	2	2	1		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					5	10	15						8	12																20				20			0.65	0.16				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	16	0	1	1	1	H1035_016_0	4	Generic	4	1	1	2	2	3		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					5	10	15						8	12																20				20			0.65	0.16				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	16	0	1	1	1	H1035_016_0	4	Preferred Brand	4	10	1	2	3	1		111	1	101		1				31	62	93	2	1		62	93				31		31								47	94	141					44	88	132						86	129																47				47			1.52	1.42				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	16	0	1	1	1	H1035_016_0	4	Non-Preferred Brand	4	10	1	2	4	1		111	1	101		1				31	62	93	2	1		62	93				31		31								100	200	300					95	190	285						188	282																100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	16	0	1	1	1	H1035_016_0	4	Specialty Tier	4	11	1	1	5	1		10	1			1				31											31		31											942.77	33						446.16	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	17	0	1	1	1	H1035_017_0	6	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	17	0	1	1	1	H1035_017_0	6	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	17	0	1	1	1	H1035_017_0	6	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	17	0	1	1	1	H1035_017_0	6	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	17	0	1	1	1	H1035_017_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					35		105					35		105																47				35			1.52	1.13	1.13			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	17	0	1	1	1	H1035_017_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	17	0	1	1	1	H1035_017_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											916.64	33						916.64	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	18	0	1	1	1	H1035_018_0	10	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H1035	18	0	1	1	1	H1035_018_0	10	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H1035	18	0	1	1	1	H1035_018_0	10	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								15		45					2		6					2		6																15				2			0.48	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H1035	18	0	1	1	1	H1035_018_0	10	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								15		45					2		6					2		6																15				2			0.48	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H1035	18	0	1	1	1	H1035_018_0	10	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					35		105					35		105																47				35			1.52	1.13	1.13			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H1035	18	0	1	1	1	H1035_018_0	10	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H1035	18	0	1	1	1	H1035_018_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											987.18	33						987.18	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H1035	18	0	1	1	1	H1035_018_0	10	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H1035	18	0	1	1	1	H1035_018_0	10	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H1035	19	0	1	1	1	H1035_019_0	6	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	19	0	1	1	1	H1035_019_0	6	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	19	0	1	1	1	H1035_019_0	6	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								15		45					10		30					10		30																15				10			0.48	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	19	0	1	1	1	H1035_019_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					40		120					40		120																47				40			1.52	1.29	1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	19	0	1	1	1	H1035_019_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	19	0	1	1	1	H1035_019_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											1135.68	33						1135.68	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	19	0	1	1	1	H1035_019_0	6	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	19	0	1	1	1	H1035_019_0	6	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	20	0	1	1	1	H1035_020_0	6	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	20	0	1	1	1	H1035_020_0	6	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	20	0	1	1	1	H1035_020_0	6	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	20	0	1	1	1	H1035_020_0	6	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	20	0	1	1	1	H1035_020_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					40		120					40		120																47				40			1.52	1.29	1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	20	0	1	1	1	H1035_020_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	20	0	1	1	1	H1035_020_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											1032.89	33						1032.89	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	20	0	1	1	1	H1035_020_0	6	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	20	0	1	1	1	H1035_020_0	6	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	21	0	1	1	1	H1035_021_0	6	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								14		42					2		6					2		6																14				2			0.45	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	21	0	1	1	1	H1035_021_0	6	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								14		42					2		6					2		6																14				2			0.45	0.06	0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	21	0	1	1	1	H1035_021_0	6	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	21	0	1	1	1	H1035_021_0	6	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	21	0	1	1	1	H1035_021_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					40		120					40		120																47				40			1.52	1.29	1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	21	0	1	1	1	H1035_021_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	21	0	1	1	1	H1035_021_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											1243.06	33						1243.06	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	21	0	1	1	1	H1035_021_0	6	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	21	0	1	1	1	H1035_021_0	6	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	22	0	1	1	1	H1035_022_0	9	Preferred Generic	4	1	3	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	22	0	1	1	1	H1035_022_0	9	Preferred Generic	4	1	3	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	22	0	1	1	1	H1035_022_0	9	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	22	0	1	1	1	H1035_022_0	9	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	22	0	1	1	1	H1035_022_0	9	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					35		105					35		105																47				35			1.52	1.13	1.13			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	22	0	1	1	1	H1035_022_0	9	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	22	0	1	1	1	H1035_022_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											1185.44	33						1185.44	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	23	0	1	1	1	H1035_023_0	8	Preferred Generic	4	1	3	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	23	0	1	1	1	H1035_023_0	8	Preferred Generic	4	1	3	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	23	0	1	1	1	H1035_023_0	8	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	23	0	1	1	1	H1035_023_0	8	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	23	0	1	1	1	H1035_023_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								45		135					25		75					25		75																45				25			1.45	0.81	0.81			0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	23	0	1	1	1	H1035_023_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								90		270					80		240					80		240																90				80			2.9	2.58	2.58			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	23	0	1	1	1	H1035_023_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											1203.89	33						1203.89	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	24	0	1	1	1	H1035_024_0	8	Preferred Generic	4	1	3	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	24	0	1	1	1	H1035_024_0	8	Preferred Generic	4	1	3	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	24	0	1	1	1	H1035_024_0	8	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	24	0	1	1	1	H1035_024_0	8	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	24	0	1	1	1	H1035_024_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								12		36					0		0					0		0																12				0			0.39	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	24	0	1	1	1	H1035_024_0	8	Preferred Brand	4	11	1	2	3	3		110	1	110		1				31		90	1	2	31		90				31		31								12		36					0		0					0		0																12				0			0.39	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	24	0	1	1	1	H1035_024_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								75		225					50		150					50		150																75				50			2.42	1.61	1.61			1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	24	0	1	1	1	H1035_024_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											938.04	33						938.04	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	25	0	1	1	1	H1035_025_0	8	Preferred Generic	4	1	3	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	25	0	1	1	1	H1035_025_0	8	Preferred Generic	4	1	3	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	25	0	1	1	1	H1035_025_0	8	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	25	0	1	1	1	H1035_025_0	8	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	25	0	1	1	1	H1035_025_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								45		135					20		60					20		60																45				20			1.45	0.65	0.65			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	25	0	1	1	1	H1035_025_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	25	0	1	1	1	H1035_025_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											825.31	33						825.31	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	26	0	1	1	1	H1035_026_0	8	Preferred Generic	4	1	3	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	26	0	1	1	1	H1035_026_0	8	Preferred Generic	4	1	3	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	26	0	1	1	1	H1035_026_0	8	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	26	0	1	1	1	H1035_026_0	8	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								11		33					0		0					0		0																11				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	26	0	1	1	1	H1035_026_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								40		120					30		90					30		90																40				30			1.29	0.97	0.97			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	26	0	1	1	1	H1035_026_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	26	0	1	1	1	H1035_026_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											863.14	33						863.14	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	27	0	1	1	1	H1035_027_0	9	Preferred Generic	4	1	3	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	27	0	1	1	1	H1035_027_0	9	Preferred Generic	4	1	3	2	1	3		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	27	0	1	1	1	H1035_027_0	9	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	27	0	1	1	1	H1035_027_0	9	Generic	4	1	1	2	2	3		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	27	0	1	1	1	H1035_027_0	9	Preferred Brand	4	11	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					40		120											47		141				40		120				47				40			1.52	1.29		1.52	1.29	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	27	0	1	1	1	H1035_027_0	9	Non-Preferred Brand	4	11	1	2	4	1		110	1		110	1				31		90	1	2				31		90	31		31								99		297					92		276											99		297				92		276				99				92			3.19	2.97		3.19	2.97	2.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	27	0	1	1	1	H1035_027_0	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											667.94	25						667.94	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	28	0	1	1	1	H1035_028_0	8	Preferred Generic	4	1	3	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	28	0	1	1	1	H1035_028_0	8	Preferred Generic	4	1	3	2	1	3		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	28	0	1	1	1	H1035_028_0	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	28	0	1	1	1	H1035_028_0	8	Generic	4	1	1	2	2	3		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	28	0	1	1	1	H1035_028_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					40		120											47		141				40		120				47				40			1.52	1.29		1.52	1.29	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	28	0	1	1	1	H1035_028_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1		110	1				31		90	1	2				31		90	31		31								99		297					92		276											99		297				92		276				99				92			3.19	2.97		3.19	2.97	2.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	28	0	1	1	1	H1035_028_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											680.58	25						680.58	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	29	0	1	1	1	H1035_029_0	8	Preferred Generic	4	1	3	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	29	0	1	1	1	H1035_029_0	8	Preferred Generic	4	1	3	2	1	3		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	29	0	1	1	1	H1035_029_0	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	29	0	1	1	1	H1035_029_0	8	Generic	4	1	1	2	2	3		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	29	0	1	1	1	H1035_029_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					40		120											47		141				40		120				47				40			1.52	1.29		1.52	1.29	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	29	0	1	1	1	H1035_029_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1		110	1				31		90	1	2				31		90	31		31								99		297					92		276											99		297				92		276				99				92			3.19	2.97		3.19	2.97	2.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	29	0	1	1	1	H1035_029_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											680.55	25						680.55	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	30	0	1	1	1	H1035_030_0	8	Preferred Generic	4	1	3	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	30	0	1	1	1	H1035_030_0	8	Preferred Generic	4	1	3	2	1	3		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	30	0	1	1	1	H1035_030_0	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	30	0	1	1	1	H1035_030_0	8	Generic	4	1	1	2	2	3		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	30	0	1	1	1	H1035_030_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					40		120											47		141				40		120				47				40			1.52	1.29		1.52	1.29	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	30	0	1	1	1	H1035_030_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1		110	1				31		90	1	2				31		90	31		31								99		297					92		276											99		297				92		276				99				92			3.19	2.97		3.19	2.97	2.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	30	0	1	1	1	H1035_030_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											675.3	25						675.3	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	31	0	1	1	1	H1035_031_0	8	Preferred Generic	4	1	3	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	31	0	1	1	1	H1035_031_0	8	Preferred Generic	4	1	3	2	1	3		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	31	0	1	1	1	H1035_031_0	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	31	0	1	1	1	H1035_031_0	8	Generic	4	1	1	2	2	3		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	31	0	1	1	1	H1035_031_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					40		120											47		141				40		120				47				40			1.52	1.29		1.52	1.29	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	31	0	1	1	1	H1035_031_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1		110	1				31		90	1	2				31		90	31		31								99		297					92		276											99		297				92		276				99				92			3.19	2.97		3.19	2.97	2.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	31	0	1	1	1	H1035_031_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											675.25	25						675.25	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	32	0	1	1	1	H1035_032_0	8	Preferred Generic	4	1	3	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	32	0	1	1	1	H1035_032_0	8	Preferred Generic	4	1	3	2	1	3		110	1		110	1				31		90	1	2				31		90	31		31								10		30					0		0											10		30				0		0				10				0			0.32	0		0.32	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	32	0	1	1	1	H1035_032_0	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	32	0	1	1	1	H1035_032_0	8	Generic	4	1	1	2	2	3		110	1		110	1				31		90	1	2				31		90	31		31								11		33					0		0											11		33				0		0				11				0			0.35	0		0.35	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	32	0	1	1	1	H1035_032_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					40		120											47		141				40		120				47				40			1.52	1.29		1.52	1.29	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	32	0	1	1	1	H1035_032_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1		110	1				31		90	1	2				31		90	31		31								99		297					92		276											99		297				92		276				99				92			3.19	2.97		3.19	2.97	2.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	32	0	1	1	1	H1035_032_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											668.87	25						668.87	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	33	0	1	1	1	H1035_033_0	8	Preferred Generic	4	1	3	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	33	0	1	1	1	H1035_033_0	8	Preferred Generic	4	1	3	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	33	0	1	1	1	H1035_033_0	8	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	33	0	1	1	1	H1035_033_0	8	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.35	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	33	0	1	1	1	H1035_033_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					40		120					40		120																47				40			1.52	1.29	1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	33	0	1	1	1	H1035_033_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	33	0	1	1	1	H1035_033_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											889.28	33						889.28	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	34	0	1	1	1	H1035_034_0	8	Preferred Generic	4	1	3	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	34	0	1	1	1	H1035_034_0	8	Preferred Generic	4	1	3	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1035	34	0	1	1	1	H1035_034_0	8	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	34	0	1	1	1	H1035_034_0	8	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	2	31		90				31		31								15		45					0		0					0		0																15				0			0.48	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	34	0	1	1	1	H1035_034_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					30		90					30		90																47				30			1.52	0.97	0.97			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	34	0	1	1	1	H1035_034_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					90		270					90		270																100				90			3.23	2.9	2.9			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	34	0	1	1	1	H1035_034_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											955.53	33						955.53	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	35	0	1	1	1	H1035_035_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	3		9																			3		9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	35	0	1	1	1	H1035_035_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	35	0	1	1	1	H1035_035_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	35	0	1	1	1	H1035_035_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	35	0	1	1	1	H1035_035_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1063.56	32																				32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	35	0	1	1	1	H1035_035_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	35	0	1	1	1	H1035_035_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	37	0	1	1	1	H1035_037_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	3		9																			3		9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	37	0	1	1	1	H1035_037_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	37	0	1	1	1	H1035_037_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	37	0	1	1	1	H1035_037_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	37	0	1	1	1	H1035_037_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1076.24	32																				32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	37	0	1	1	1	H1035_037_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	37	0	1	1	1	H1035_037_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	38	0	1	1	1	H1035_038_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	3		9																			3		9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	38	0	1	1	1	H1035_038_0	6	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	38	0	1	1	1	H1035_038_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	38	0	1	1	1	H1035_038_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	38	0	1	1	1	H1035_038_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1082.78	32																				32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	38	0	1	1	1	H1035_038_0	6	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1035	38	0	1	1	1	H1035_038_0	6	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1035	39	0	1	1	1	H1035_039_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1035	39	0	1	1	1	H1035_039_0	7	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1035	39	0	1	1	1	H1035_039_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1035	39	0	1	1	1	H1035_039_0	7	Generic	4	1	1	2	2	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1035	39	0	1	1	1	H1035_039_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	25		75																			25		75																25				25		0.81			0.81			0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1035	39	0	1	1	1	H1035_039_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	50		150																			50		150																50				50		1.61			1.61			1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1035	39	0	1	1	1	H1035_039_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1114.53	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1035	40	0	1	1	1	H1035_040_0	4	Preferred Generic	4	1	1	2	1	1		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	40	0	1	1	1	H1035_040_0	4	Preferred Generic	4	1	1	2	1	3		111	1	101		1				31	62	93	2	1		62	93				31		31								17	34	51					0	0	0						0	0																17				17			0.55	0				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	40	0	1	1	1	H1035_040_0	4	Generic	4	1	1	2	2	1		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					5	10	15						8	12																20				20			0.65	0.16				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	40	0	1	1	1	H1035_040_0	4	Generic	4	1	1	2	2	3		111	1	101		1				31	62	93	2	1		62	93				31		31								20	40	60					5	10	15						8	12																20				20			0.65	0.16				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1035	40	0	1	1	1	H1035_040_0	4	Preferred Brand	4	10	1	2	3	1		111	1	101		1				31	62	93	2	1		62	93				31		31								47	94	141					44	88	132						86	129																47				47			1.52	1.42				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	40	0	1	1	1	H1035_040_0	4	Non-Preferred Brand	4	10	1	2	4	1		111	1	101		1				31	62	93	2	1		62	93				31		31								100	200	300					95	190	285						188	282																100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1035	40	0	1	1	1	H1035_040_0	4	Specialty Tier	4	11	1	1	5	1		10	1			1				31											31		31											942.77	33						446.16	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1036	25	0	1	1	1	H1036_025_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	25	0	1	1	1	H1036_025_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	25	0	1	1	1	H1036_025_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	25	0	1	1	1	H1036_025_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	25	0	1	1	1	H1036_025_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					5		15											47		141				5		5				47				47			1.57	0.17		1.57	0.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	25	0	1	1	1	H1036_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					55		165											100		300				55		155				100				100			3.33	1.83		3.33	1.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	25	0	1	1	1	H1036_025_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	44	0	1	1	1	H1036_044_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	44	0	1	1	1	H1036_044_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	44	0	1	1	1	H1036_044_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	44	0	1	1	1	H1036_044_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	44	0	1	1	1	H1036_044_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	44	0	1	1	1	H1036_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	44	0	1	1	1	H1036_044_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	54	0	1	1	1	H1036_054_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	54	0	1	1	1	H1036_054_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	54	0	1	1	1	H1036_054_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	54	0	1	1	1	H1036_054_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	54	0	1	1	1	H1036_054_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	54	0	1	1	1	H1036_054_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								50		150					45		135											50		150				45		125				50				50			1.67	1.5		1.67	1.5	1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	54	0	1	1	1	H1036_054_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	62	0	1	1	1	H1036_062_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	62	0	1	1	1	H1036_062_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	62	0	1	1	1	H1036_062_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	62	0	1	1	1	H1036_062_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	62	0	1	1	1	H1036_062_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					20		60											47		141				20		50				47				47			1.57	0.67		1.57	0.67	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	62	0	1	1	1	H1036_062_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					75		225											100		300				75		215				100				100			3.33	2.5		3.33	2.5	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	62	0	1	1	1	H1036_062_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	65	0	1	1	1	H1036_065_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	65	0	1	1	1	H1036_065_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	65	0	1	1	1	H1036_065_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	65	0	1	1	1	H1036_065_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	65	0	1	1	1	H1036_065_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					20		60											47		141				20		50				47				47			1.57	0.67		1.57	0.67	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	65	0	1	1	1	H1036_065_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	65	0	1	1	1	H1036_065_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	68	0	1	1	1	H1036_068_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	68	0	1	1	1	H1036_068_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	68	0	1	1	1	H1036_068_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	68	0	1	1	1	H1036_068_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	68	0	1	1	1	H1036_068_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	68	0	1	1	1	H1036_068_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					89		267											100		300				89		257				100				100			3.33	2.97		3.33	2.97	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	68	0	1	1	1	H1036_068_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	74	0	1	1	1	H1036_074_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	74	0	1	1	1	H1036_074_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	74	0	1	1	1	H1036_074_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	74	0	1	1	1	H1036_074_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	74	0	1	1	1	H1036_074_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					10		30											47		141				10		20				47				47			1.57	0.33		1.57	0.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	74	0	1	1	1	H1036_074_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					60		180											100		300				60		170				100				100			3.33	2		3.33	2	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	74	0	1	1	1	H1036_074_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	77	0	1	1	1	H1036_077_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	77	0	1	1	1	H1036_077_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	77	0	1	1	1	H1036_077_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	77	0	1	1	1	H1036_077_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	77	0	1	1	1	H1036_077_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	81	0	1	1	1	H1036_081_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	81	0	1	1	1	H1036_081_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	81	0	1	1	1	H1036_081_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	81	0	1	1	1	H1036_081_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	81	0	1	1	1	H1036_081_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	81	0	1	1	1	H1036_081_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					89		267											100		300				89		257				100				100			3.33	2.97		3.33	2.97	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	81	0	1	1	1	H1036_081_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	102	0	1	1	1	H1036_102_0	6	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	102	0	1	1	1	H1036_102_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	102	0	1	1	1	H1036_102_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	102	0	1	1	1	H1036_102_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	102	0	1	1	1	H1036_102_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_103_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	103	0	1	1	1	H1036_103_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	103	0	1	1	1	H1036_103_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	103	0	1	1	1	H1036_103_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	103	0	1	1	1	H1036_103_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_104_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	104	0	1	1	1	H1036_104_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	104	0	1	1	1	H1036_104_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	104	0	1	1	1	H1036_104_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	104	0	1	1	1	H1036_104_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_121_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	121	0	1	1	1	H1036_121_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	121	0	1	1	1	H1036_121_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	121	0	1	1	1	H1036_121_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	121	0	1	1	1	H1036_121_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								45		135					40		120											45		135				40		110				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	121	0	1	1	1	H1036_121_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								90		270					85		255											90		270				85		245				90				90			3	2.83		3	2.83	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	121	0	1	1	1	H1036_121_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	130	0	1	1	1	H1036_130_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	130	0	1	1	1	H1036_130_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	130	0	1	1	1	H1036_130_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								12		36					7		21											12		36				7		0				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	130	0	1	1	1	H1036_130_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								12		36					7		21											12		36				7		0				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	130	0	1	1	1	H1036_130_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	130	0	1	1	1	H1036_130_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	130	0	1	1	1	H1036_130_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	137	0	1	1	1	H1036_137_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	137	0	1	1	1	H1036_137_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	137	0	1	1	1	H1036_137_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	137	0	1	1	1	H1036_137_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	137	0	1	1	1	H1036_137_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	140	0	1	1	1	H1036_140_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	140	0	1	1	1	H1036_140_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	140	0	1	1	1	H1036_140_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	140	0	1	1	1	H1036_140_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	140	0	1	1	1	H1036_140_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	140	0	1	1	1	H1036_140_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					75		225											100		300				75		215				100				100			3.33	2.5		3.33	2.5	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	140	0	1	1	1	H1036_140_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	143	0	1	1	1	H1036_143_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	143	0	1	1	1	H1036_143_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	3
H1036	143	0	1	1	1	H1036_143_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	143	0	1	1	1	H1036_143_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H1036	143	0	1	1	1	H1036_143_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	143	0	1	1	1	H1036_143_0	4	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H1036	143	0	1	1	1	H1036_143_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	143	0	1	1	1	H1036_143_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H1036	143	0	1	1	1	H1036_143_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	143	0	1	1	1	H1036_143_0	4	Specialty Tier	4	11	1	1	5	3		10	1		10	1				30								30			30		31												15							15												15						15					15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H1036	146	0	1	1	1	H1036_146_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	146	0	1	1	1	H1036_146_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	146	0	1	1	1	H1036_146_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	146	0	1	1	1	H1036_146_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	146	0	1	1	1	H1036_146_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					35		105											47		141				35		95				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	146	0	1	1	1	H1036_146_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	146	0	1	1	1	H1036_146_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	151	0	1	1	1	H1036_151_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	151	0	1	1	1	H1036_151_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	151	0	1	1	1	H1036_151_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	151	0	1	1	1	H1036_151_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	151	0	1	1	1	H1036_151_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	153	0	1	1	1	H1036_153_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	153	0	1	1	1	H1036_153_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	153	0	1	1	1	H1036_153_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	153	0	1	1	1	H1036_153_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	153	0	1	1	1	H1036_153_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	156	0	1	1	1	H1036_156_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	156	0	1	1	1	H1036_156_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					7		21											20		60				7		0				20				20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	156	0	1	1	1	H1036_156_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	156	0	1	1	1	H1036_156_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	156	0	1	1	1	H1036_156_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	156	0	1	1	1	H1036_156_0	4	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	156	0	1	1	1	H1036_156_0	4	Select Care Drugs	4	11	1	2	6	3		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1036	157	0	1	1	1	H1036_157_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	157	0	1	1	1	H1036_157_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	157	0	1	1	1	H1036_157_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	157	0	1	1	1	H1036_157_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					85		255											100		300				85		245				100				100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	157	0	1	1	1	H1036_157_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	160	0	1	1	1	H1036_160_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	160	0	1	1	1	H1036_160_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	3
H1036	160	0	1	1	1	H1036_160_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	160	0	1	1	1	H1036_160_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	160	0	1	1	1	H1036_160_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					5		15											47		141				5		5				47				47			1.57	0.17		1.57	0.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	160	0	1	1	1	H1036_160_0	3	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	2	2				30		90	30		31								47		141					5		15											47		141				5		5				47				47			1.57	0.17		1.57	0.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	160	0	1	1	1	H1036_160_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					35		105											100		300				35		95				100				100			3.33	1.17		3.33	1.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	160	0	1	1	1	H1036_160_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	1		110	1				30		90	2	2				30		90	30		31								100		300					35		105											100		300				35		95				100				100			3.33	1.17		3.33	1.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	160	0	1	1	1	H1036_160_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_160_0	3	Specialty Tier	4	11	1	1	5	3		10	1		10	1				30								30			30		31												15							15												15						15					15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	160	0	1	1	1	H1036_160_0	3	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	160	0	1	1	1	H1036_160_0	3	Select Care Drugs	4	11	1	2	6	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1036	167	0	1	1	1	H1036_167_0	7	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	167	0	1	1	1	H1036_167_0	7	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								18		54					13		39											18		54				13		0				18				18			0.6	0.43		0.6	0.43	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	167	0	1	1	1	H1036_167_0	7	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	167	0	1	1	1	H1036_167_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	167	0	1	1	1	H1036_167_0	7	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	168	0	1	1	1	H1036_168_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	168	0	1	1	1	H1036_168_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	168	0	1	1	1	H1036_168_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	168	0	1	1	1	H1036_168_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	168	0	1	1	1	H1036_168_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	171	0	1	1	1	H1036_171_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	171	0	1	1	1	H1036_171_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	171	0	1	1	1	H1036_171_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	171	0	1	1	1	H1036_171_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	171	0	1	1	1	H1036_171_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	175	0	1	1	1	H1036_175_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	175	0	1	1	1	H1036_175_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	3
H1036	175	0	1	1	1	H1036_175_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	175	0	1	1	1	H1036_175_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	175	0	1	1	1	H1036_175_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	175	0	1	1	1	H1036_175_0	4	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	175	0	1	1	1	H1036_175_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					89		267											100		300				89		257				100				100			3.33	2.97		3.33	2.97	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	175	0	1	1	1	H1036_175_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	1		110	1				30		90	2	2				30		90	30		31								100		300					89		267											100		300				89		257				100				100			3.33	2.97		3.33	2.97	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	175	0	1	1	1	H1036_175_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_175_0	4	Specialty Tier	4	11	1	1	5	3		10	1		10	1				30								30			30		31												15							15												15						15					15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1036	175	0	1	1	1	H1036_175_0	4	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	175	0	1	1	1	H1036_175_0	4	Select Care Drugs	4	11	1	2	6	3		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1036	199	0	1	1	1	H1036_199_0	5	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	199	0	1	1	1	H1036_199_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	199	0	1	1	1	H1036_199_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	199	0	1	1	1	H1036_199_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	199	0	1	1	1	H1036_199_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	209	0	1	1	1	H1036_209_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	209	0	1	1	1	H1036_209_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					1		3											20		60				1		0				20				20			0.67	0.03		0.67	0.03	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	209	0	1	1	1	H1036_209_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	209	0	1	1	1	H1036_209_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	209	0	1	1	1	H1036_209_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	210	0	1	1	1	H1036_210_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	210	0	1	1	1	H1036_210_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	210	0	1	1	1	H1036_210_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	210	0	1	1	1	H1036_210_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	210	0	1	1	1	H1036_210_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_213_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	213	0	1	1	1	H1036_213_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	213	0	1	1	1	H1036_213_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	213	0	1	1	1	H1036_213_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	213	0	1	1	1	H1036_213_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_214_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	214	0	1	1	1	H1036_214_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	214	0	1	1	1	H1036_214_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	214	0	1	1	1	H1036_214_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	214	0	1	1	1	H1036_214_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	215	0	1	1	1	H1036_215_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	215	0	1	1	1	H1036_215_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	215	0	1	1	1	H1036_215_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	215	0	1	1	1	H1036_215_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	215	0	1	1	1	H1036_215_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					35		105											47		141				35		95				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	215	0	1	1	1	H1036_215_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	215	0	1	1	1	H1036_215_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_217_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	217	0	1	1	1	H1036_217_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	217	0	1	1	1	H1036_217_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	217	0	1	1	1	H1036_217_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	217	0	1	1	1	H1036_217_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	217	0	1	1	1	H1036_217_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	217	0	1	1	1	H1036_217_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	219	0	1	1	1	H1036_219_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	219	0	1	1	1	H1036_219_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	219	0	1	1	1	H1036_219_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	219	0	1	1	1	H1036_219_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	219	0	1	1	1	H1036_219_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	222	0	1	1	1	H1036_222_0	5	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	222	0	1	1	1	H1036_222_0	5	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	222	0	1	1	1	H1036_222_0	5	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	222	0	1	1	1	H1036_222_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	222	0	1	1	1	H1036_222_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	223	0	1	1	1	H1036_223_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	223	0	1	1	1	H1036_223_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	223	0	1	1	1	H1036_223_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	223	0	1	1	1	H1036_223_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	223	0	1	1	1	H1036_223_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	226	0	1	1	1	H1036_226_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	226	0	1	1	1	H1036_226_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	226	0	1	1	1	H1036_226_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	226	0	1	1	1	H1036_226_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	226	0	1	1	1	H1036_226_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_229_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	229	0	1	1	1	H1036_229_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	229	0	1	1	1	H1036_229_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					30		90											47		141				30		80				47				47			1.57	1		1.57	1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	229	0	1	1	1	H1036_229_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	229	0	1	1	1	H1036_229_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_230_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	230	0	1	1	1	H1036_230_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								15		45					5		15											15		45				5		0				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	230	0	1	1	1	H1036_230_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					30		90											47		141				30		80				47				47			1.57	1		1.57	1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	230	0	1	1	1	H1036_230_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	230	0	1	1	1	H1036_230_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	231	0	1	1	1	H1036_231_0	6	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	231	0	1	1	1	H1036_231_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					1		3											20		60				1		0				20				20			0.67	0.03		0.67	0.03	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	231	0	1	1	1	H1036_231_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	231	0	1	1	1	H1036_231_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	231	0	1	1	1	H1036_231_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_233_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	233	0	1	1	1	H1036_233_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	233	0	1	1	1	H1036_233_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	233	0	1	1	1	H1036_233_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	233	0	1	1	1	H1036_233_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	234	0	1	1	1	H1036_234_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	234	0	1	1	1	H1036_234_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					14		42											20		60				14		0				20				20			0.67	0.47		0.67	0.47	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	234	0	1	1	1	H1036_234_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			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	1	1	H1036_234_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			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	1	1	H1036_234_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	234	0	1	1	1	H1036_234_0	3	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1036	235	0	1	1	1	H1036_235_0	7	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	235	0	1	1	1	H1036_235_0	7	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	235	0	1	1	1	H1036_235_0	7	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	235	0	1	1	1	H1036_235_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	235	0	1	1	1	H1036_235_0	7	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	236	0	1	1	1	H1036_236_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	236	0	1	1	1	H1036_236_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					14		42											20		60				14		0				20				20			0.67	0.47		0.67	0.47	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	236	0	1	1	1	H1036_236_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	236	0	1	1	1	H1036_236_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	236	0	1	1	1	H1036_236_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_237_1	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	1	1	1	1	H1036_237_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	1	1	1	1	H1036_237_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	1	1	1	1	H1036_237_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	1	1	1	1	H1036_237_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_237_2	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	2	1	1	1	H1036_237_2	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	2	1	1	1	H1036_237_2	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	2	1	1	1	H1036_237_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	237	2	1	1	1	H1036_237_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	241	0	1	1	1	H1036_241_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	241	0	1	1	1	H1036_241_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	241	0	1	1	1	H1036_241_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	241	0	1	1	1	H1036_241_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	241	0	1	1	1	H1036_241_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	243	0	1	1	1	H1036_243_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	243	0	1	1	1	H1036_243_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	243	0	1	1	1	H1036_243_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	243	0	1	1	1	H1036_243_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	243	0	1	1	1	H1036_243_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	245	0	1	1	1	H1036_245_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	245	0	1	1	1	H1036_245_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	245	0	1	1	1	H1036_245_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	245	0	1	1	1	H1036_245_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	245	0	1	1	1	H1036_245_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	247	0	1	1	1	H1036_247_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	247	0	1	1	1	H1036_247_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	247	0	1	1	1	H1036_247_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	247	0	1	1	1	H1036_247_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	247	0	1	1	1	H1036_247_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_249_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	249	0	1	1	1	H1036_249_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	249	0	1	1	1	H1036_249_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	249	0	1	1	1	H1036_249_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	249	0	1	1	1	H1036_249_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_251_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	251	0	1	1	1	H1036_251_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					2		6											20		60				2		0				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	251	0	1	1	1	H1036_251_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	251	0	1	1	1	H1036_251_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	251	0	1	1	1	H1036_251_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_253_0	6	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	253	0	1	1	1	H1036_253_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					1		3											20		60				1		0				20				20			0.67	0.03		0.67	0.03	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	253	0	1	1	1	H1036_253_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	253	0	1	1	1	H1036_253_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	253	0	1	1	1	H1036_253_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_255_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	255	0	1	1	1	H1036_255_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	255	0	1	1	1	H1036_255_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	255	0	1	1	1	H1036_255_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	255	0	1	1	1	H1036_255_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_257_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	257	0	1	1	1	H1036_257_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	257	0	1	1	1	H1036_257_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	257	0	1	1	1	H1036_257_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	257	0	1	1	1	H1036_257_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_259_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	259	0	1	1	1	H1036_259_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	259	0	1	1	1	H1036_259_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	259	0	1	1	1	H1036_259_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	259	0	1	1	1	H1036_259_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_261_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	261	0	1	1	1	H1036_261_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					2		6											20		60				2		0				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	261	0	1	1	1	H1036_261_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	261	0	1	1	1	H1036_261_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	261	0	1	1	1	H1036_261_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	1	H1036_262_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	262	0	1	1	1	H1036_262_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					2		6											20		60				2		0				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	262	0	1	1	1	H1036_262_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	262	0	1	1	1	H1036_262_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	262	0	1	1	1	H1036_262_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	263	0	1	1	1	H1036_263_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	263	0	1	1	1	H1036_263_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	263	0	1	1	1	H1036_263_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	263	0	1	1	1	H1036_263_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	263	0	1	1	1	H1036_263_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	264	0	1	1	1	H1036_264_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	264	0	1	1	1	H1036_264_0	2	Generic	4	11	1	1	2	1		110	1		110	1				30		90	2	2				30		90	30		31											8	25		25				6	24		24										25		25				24		24			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	264	0	1	1	1	H1036_264_0	2	Preferred Brand	4	11	1	1	3	1		110	1		110	1				30		90	2	2				30		90	30		31											42	25		25				40	24		24										25		25				24		24			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	264	0	1	1	1	H1036_264_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											74	25		25				45	24		24										25		25				24		24			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	264	0	1	1	1	H1036_264_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	1	1	1	1	H1036_265_1	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	1	1	1	1	H1036_265_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	1	1	1	1	H1036_265_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	1	1	1	1	H1036_265_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	1	1	1	1	H1036_265_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	2	1	1	1	H1036_265_2	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	2	1	1	1	H1036_265_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	2	1	1	1	H1036_265_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	2	1	1	1	H1036_265_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	265	2	1	1	1	H1036_265_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	266	0	1	1	1	H1036_266_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	266	0	1	1	1	H1036_266_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					3		9											20		60				3		0				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	266	0	1	1	1	H1036_266_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	266	0	1	1	1	H1036_266_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	266	0	1	1	1	H1036_266_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	267	0	1	1	1	H1036_267_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	267	0	1	1	1	H1036_267_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	267	0	1	1	1	H1036_267_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	267	0	1	1	1	H1036_267_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	267	0	1	1	1	H1036_267_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	268	0	1	1	1	H1036_268_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	268	0	1	1	1	H1036_268_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	268	0	1	1	1	H1036_268_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	268	0	1	1	1	H1036_268_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	268	0	1	1	1	H1036_268_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	269	0	1	1	1	H1036_269_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	269	0	1	1	1	H1036_269_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	269	0	1	1	1	H1036_269_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	269	0	1	1	1	H1036_269_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	269	0	1	1	1	H1036_269_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	270	0	1	1	1	H1036_270_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	270	0	1	1	1	H1036_270_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	270	0	1	1	1	H1036_270_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	270	0	1	1	1	H1036_270_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	270	0	1	1	1	H1036_270_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	271	0	1	1	1	H1036_271_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	271	0	1	1	1	H1036_271_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	271	0	1	1	1	H1036_271_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	271	0	1	1	1	H1036_271_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	271	0	1	1	1	H1036_271_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	1	1	1	1	H1036_275_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	1	1	1	1	H1036_275_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	1	1	1	1	H1036_275_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	1	1	1	1	H1036_275_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	1	1	1	1	H1036_275_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	2	1	1	1	H1036_275_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	2	1	1	1	H1036_275_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	2	1	1	1	H1036_275_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	2	1	1	1	H1036_275_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	275	2	1	1	1	H1036_275_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	276	0	1	1	1	H1036_276_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	276	0	1	1	1	H1036_276_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	276	0	1	1	1	H1036_276_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	276	0	1	1	1	H1036_276_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	276	0	1	1	1	H1036_276_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	277	0	1	1	1	H1036_277_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	277	0	1	1	1	H1036_277_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1036	277	0	1	1	1	H1036_277_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	277	0	1	1	1	H1036_277_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1036	277	0	1	1	1	H1036_277_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	277	0	1	1	1	H1036_277_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					90		270											100		300				90		260				100				100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	277	0	1	1	1	H1036_277_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	278	0	1	1	1	H1036_278_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	278	0	1	1	1	H1036_278_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	278	0	1	1	1	H1036_278_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	278	0	1	1	1	H1036_278_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	278	0	1	1	1	H1036_278_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	280	0	1	1	1	H1036_280_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	280	0	1	1	1	H1036_280_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	280	0	1	1	1	H1036_280_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	280	0	1	1	1	H1036_280_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	280	0	1	1	1	H1036_280_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	281	0	1	1	1	H1036_281_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	281	0	1	1	1	H1036_281_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	281	0	1	1	1	H1036_281_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	281	0	1	1	1	H1036_281_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	281	0	1	1	1	H1036_281_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	282	0	1	1	1	H1036_282_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	282	0	1	1	1	H1036_282_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	282	0	1	1	1	H1036_282_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	282	0	1	1	1	H1036_282_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	282	0	1	1	1	H1036_282_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	283	0	1	1	1	H1036_283_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	283	0	1	1	1	H1036_283_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					3		9											20		60				3		0				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	283	0	1	1	1	H1036_283_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	283	0	1	1	1	H1036_283_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	283	0	1	1	1	H1036_283_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	284	0	1	1	1	H1036_284_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	284	0	1	1	1	H1036_284_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	284	0	1	1	1	H1036_284_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	284	0	1	1	1	H1036_284_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	284	0	1	1	1	H1036_284_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	285	0	1	1	1	H1036_285_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	285	0	1	1	1	H1036_285_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	285	0	1	1	1	H1036_285_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	285	0	1	1	1	H1036_285_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1036	285	0	1	1	1	H1036_285_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	1	0	1	1	1	H1045_001_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	1	0	1	1	1	H1045_001_0	2	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	1	0	1	1	1	H1045_001_0	2	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	1	0	1	1	1	H1045_001_0	2	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1045	1	0	1	1	1	H1045_001_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	1	0	1	1	1	H1045_001_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	40		120																											120						110				40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	1	0	1	1	1	H1045_001_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				878	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	5	0	1	1	1	H1045_005_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	5	0	1	1	1	H1045_005_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	5	0	1	1	1	H1045_005_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	5	0	1	1	1	H1045_005_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1045	5	0	1	1	1	H1045_005_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	5	0	1	1	1	H1045_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	5	0	1	1	1	H1045_005_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				821	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	12	0	1	1	1	H1045_012_0	3	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	12	0	1	1	1	H1045_012_0	3	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	12	0	1	1	1	H1045_012_0	3	Generic	4	1	3	2	2	1	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	12	0	1	1	1	H1045_012_0	3	Generic	4	1	3	2	2	3	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1045	12	0	1	1	1	H1045_012_0	3	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		100				2	2			100				30		31				43	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	12	0	1	1	1	H1045_012_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		100				2	2			100				30		31				46	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	12	0	1	1	1	H1045_012_0	3	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		100				2	2			100				30		31				591	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	18	0	1	1	1	H1045_018_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	18	0	1	1	1	H1045_018_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	18	0	1	1	1	H1045_018_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	18	0	1	1	1	H1045_018_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1045	18	0	1	1	1	H1045_018_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	15		45																											45						35				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	18	0	1	1	1	H1045_018_0	3	Preferred Brand	4	11	1	2	3	3	110		1		100	1	30		100				2	2						100	30		31	15		45																											45						35				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	18	0	1	1	1	H1045_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	18	0	1	1	1	H1045_018_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				781	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	25	0	1	1	1	H1045_025_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	25	0	1	1	1	H1045_025_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	7		21																											21						0				7				7		0.23						0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	25	0	1	1	1	H1045_025_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	7		21																											21						0				7				7		0.23						0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1045	25	0	1	1	1	H1045_025_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	25	0	1	1	1	H1045_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	25	0	1	1	1	H1045_025_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1274	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	26	0	1	2	1	H1045_026_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	26	0	1	2	1	H1045_026_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	26	0	1	2	1	H1045_026_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	26	0	1	2	1	H1045_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	26	0	1	2	1	H1045_026_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				830	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	27	0	1	2	1	H1045_027_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	27	0	1	2	1	H1045_027_0	2	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	27	0	1	2	1	H1045_027_0	2	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1045	27	0	1	2	1	H1045_027_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	27	0	1	2	1	H1045_027_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	27	0	1	2	1	H1045_027_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1055	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	28	0	1	2	1	H1045_028_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	28	0	1	2	1	H1045_028_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	28	0	1	2	1	H1045_028_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	28	0	1	2	1	H1045_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	28	0	1	2	1	H1045_028_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1078	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	30	0	1	2	1	H1045_030_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	30	0	1	2	1	H1045_030_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	30	0	1	2	1	H1045_030_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	30	0	1	2	1	H1045_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	30	0	1	2	1	H1045_030_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				977	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	31	0	1	2	1	H1045_031_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	31	0	1	2	1	H1045_031_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	31	0	1	2	1	H1045_031_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	31	0	1	2	1	H1045_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	31	0	1	2	1	H1045_031_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1025	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	32	0	1	2	1	H1045_032_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	32	0	1	2	1	H1045_032_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	32	0	1	2	1	H1045_032_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	32	0	1	2	1	H1045_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	32	0	1	2	1	H1045_032_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1172	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	33	0	1	1	1	H1045_033_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	33	0	1	1	1	H1045_033_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	33	0	1	1	1	H1045_033_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	33	0	1	1	1	H1045_033_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	33	0	1	1	1	H1045_033_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				861	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	34	0	1	1	1	H1045_034_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	34	0	1	1	1	H1045_034_0	2	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	34	0	1	1	1	H1045_034_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	34	0	1	1	1	H1045_034_0	2	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	34	0	1	1	1	H1045_034_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	34	0	1	1	1	H1045_034_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	34	0	1	1	1	H1045_034_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1211	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	36	0	1	2	1	H1045_036_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	36	0	1	2	1	H1045_036_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	36	0	1	2	1	H1045_036_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	36	0	1	2	1	H1045_036_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	36	0	1	2	1	H1045_036_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1090	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	37	0	1	1	1	H1045_037_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	37	0	1	1	1	H1045_037_0	2	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	37	0	1	1	1	H1045_037_0	2	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	37	0	1	1	1	H1045_037_0	2	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1045	37	0	1	1	1	H1045_037_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	37	0	1	1	1	H1045_037_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	37	0	1	1	1	H1045_037_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				805	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	38	0	1	1	1	H1045_038_0	2	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	38	0	1	1	1	H1045_038_0	2	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	38	0	1	1	1	H1045_038_0	2	Generic	4	1	3	2	2	1	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	38	0	1	1	1	H1045_038_0	2	Generic	4	1	3	2	2	3	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1045	38	0	1	1	1	H1045_038_0	2	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		100				2	2			100				30		31				48	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	38	0	1	1	1	H1045_038_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		100				2	2			100				30		31				50	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	38	0	1	1	1	H1045_038_0	2	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		100				2	2			100				30		31				611	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	39	0	1	1	1	H1045_039_0	2	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	39	0	1	1	1	H1045_039_0	2	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31				4	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	39	0	1	1	1	H1045_039_0	2	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				38	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	39	0	1	1	1	H1045_039_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				47	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	39	0	1	1	1	H1045_039_0	2	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31				573	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	41	0	1	2	1	H1045_041_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	41	0	1	2	1	H1045_041_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	41	0	1	2	1	H1045_041_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	41	0	1	2	1	H1045_041_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	41	0	1	2	1	H1045_041_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				956	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	42	0	1	2	1	H1045_042_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	42	0	1	2	1	H1045_042_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	42	0	1	2	1	H1045_042_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	42	0	1	2	1	H1045_042_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	42	0	1	2	1	H1045_042_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				984	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	43	0	1	2	1	H1045_043_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	43	0	1	2	1	H1045_043_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	43	0	1	2	1	H1045_043_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	43	0	1	2	1	H1045_043_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	43	0	1	2	1	H1045_043_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				928	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	45	0	1	2	1	H1045_045_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	45	0	1	2	1	H1045_045_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	45	0	1	2	1	H1045_045_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	45	0	1	2	1	H1045_045_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1045	45	0	1	2	1	H1045_045_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	45	0	1	2	1	H1045_045_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	45	0	1	2	1	H1045_045_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1078	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	1	1	1	1	H1045_048_1	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	1	1	1	1	H1045_048_1	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		0													60						0				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	1	1	1	1	H1045_048_1	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	1	1	1	1	H1045_048_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	1	1	1	1	H1045_048_1	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											799	30		30				661	30		30												30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	2	1	1	1	H1045_048_2	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	2	1	1	1	H1045_048_2	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		0													60						0				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	2	1	1	1	H1045_048_2	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	2	1	1	1	H1045_048_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	2	1	1	1	H1045_048_2	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											799	30		30				661	30		30												30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	3	1	1	1	H1045_048_3	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	3	1	1	1	H1045_048_3	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		0													60						0				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	3	1	1	1	H1045_048_3	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	3	1	1	1	H1045_048_3	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	3	1	1	1	H1045_048_3	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											799	30		30				661	30		30												30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	4	1	1	1	H1045_048_4	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	4	1	1	1	H1045_048_4	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		0													60						0				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	4	1	1	1	H1045_048_4	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	4	1	1	1	H1045_048_4	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1045	48	4	1	1	1	H1045_048_4	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											799	30		30				661	30		30												30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1099	1	0	1	2	1	H1099_001_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	1	0	1	2	1	H1099_001_0	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1099	1	0	1	2	1	H1099_001_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	1	0	1	2	1	H1099_001_0	7	Generic	4	1	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	15		45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1099	1	0	1	2	1	H1099_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	1	0	1	2	1	H1099_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	1	0	1	2	1	H1099_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				856.92	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	1	0	1	2	1	H1099_001_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	1	0	1	2	1	H1099_001_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1099	6	0	1	1	1	H1099_006_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	6	0	1	1	1	H1099_006_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	6	0	1	1	1	H1099_006_0	8	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	6	0	1	1	1	H1099_006_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	6	0	1	1	1	H1099_006_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				874	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	6	0	1	1	1	H1099_006_0	8	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	6	0	1	1	1	H1099_006_0	8	Select Care Drugs	4	1	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1099	14	0	1	1	1	H1099_014_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	14	0	1	1	1	H1099_014_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	14	0	1	1	1	H1099_014_0	8	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	14	0	1	1	1	H1099_014_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	14	0	1	1	1	H1099_014_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				956.4	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	14	0	1	1	1	H1099_014_0	8	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	16	0	1	1	1	H1099_016_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		6																					0																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	16	0	1	1	1	H1099_016_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					0																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	16	0	1	1	1	H1099_016_0	5	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	16	0	1	1	1	H1099_016_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	16	0	1	1	1	H1099_016_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				773.74	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	16	0	1	1	1	H1099_016_0	5	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1099	16	0	1	1	1	H1099_016_0	5	Select Care Drugs	4	1	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1100	1	0	1	4	1	H1100_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	1	0	1	4	1	H1100_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1100	1	0	1	4	1	H1100_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	1	0	1	4	1	H1100_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1100	1	0	1	4	1	H1100_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	1	0	1	4	1	H1100_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	1	0	1	4	1	H1100_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											657.34	33						587.98	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	2	0	1	4	1	H1100_002_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	2	0	1	4	1	H1100_002_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1100	2	0	1	4	1	H1100_002_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	2	0	1	4	1	H1100_002_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1100	2	0	1	4	1	H1100_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	2	0	1	4	1	H1100_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1100	2	0	1	4	1	H1100_002_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											774.65	33						728.37	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	5	0	1	1	1	H1109_005_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	5	0	1	1	1	H1109_005_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1109	5	0	1	1	1	H1109_005_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	5	0	1	1	1	H1109_005_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1109	5	0	1	1	1	H1109_005_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	5	0	1	1	1	H1109_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	5	0	1	1	1	H1109_005_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											577.22	29						534.54	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	6	0	1	1	1	H1109_006_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	6	0	1	1	1	H1109_006_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1109	6	0	1	1	1	H1109_006_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	6	0	1	1	1	H1109_006_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1109	6	0	1	1	1	H1109_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	6	0	1	1	1	H1109_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1109	6	0	1	1	1	H1109_006_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.59	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1111	9	1	1	1	1	H1111_009_1	8	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								7		21					0		0													21						0				7				7			0.23	0				0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	1	1	1	1	H1111_009_1	8	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		10													45						10				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	1	1	1	1	H1111_009_1	8	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	1	1	1	1	H1111_009_1	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								95		285					95		275													285						275				95				95			3.16	3.16				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	1	1	1	1	H1111_009_1	8	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											905	28		28				756	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	2	1	1	1	H1111_009_2	8	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								7		21					0		0													21						0				7				7			0.23	0				0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	2	1	1	1	H1111_009_2	8	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		10													45						10				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	2	1	1	1	H1111_009_2	8	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	2	1	1	1	H1111_009_2	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								95		285					95		275													285						275				95				95			3.16	3.16				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	9	2	1	1	1	H1111_009_2	8	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											905	28		28				756	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	1	1	1	1	H1111_010_1	8	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								7		21					0		0													21						0				7				7			0.23	0				0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	1	1	1	1	H1111_010_1	8	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		10													45						10				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	1	1	1	1	H1111_010_1	8	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	1	1	1	1	H1111_010_1	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								95		285					95		275													285						275				95				95			3.16	3.16				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	1	1	1	1	H1111_010_1	8	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											989	29		29				796	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	2	1	1	1	H1111_010_2	8	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								7		21					0		0													21						0				7				7			0.23	0				0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	2	1	1	1	H1111_010_2	8	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		10													45						10				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	2	1	1	1	H1111_010_2	8	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	2	1	1	1	H1111_010_2	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								95		285					95		275													285						275				95				95			3.16	3.16				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1111	10	2	1	1	1	H1111_010_2	8	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											989	29		29				796	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	6	0	1	1	1	H1112_006_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	6	0	1	1	1	H1112_006_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	6	0	1	1	1	H1112_006_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	6	0	1	1	1	H1112_006_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.48	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	6	0	1	1	1	H1112_006_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	33	0	1	1	1	H1112_033_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	33	0	1	1	1	H1112_033_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	33	0	1	1	1	H1112_033_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	33	0	1	1	1	H1112_033_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.82	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	33	0	1	1	1	H1112_033_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	35	0	1	1	1	H1112_035_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	35	0	1	1	1	H1112_035_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H1112	35	0	1	1	1	H1112_035_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	35	0	1	1	1	H1112_035_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	35	0	1	1	1	H1112_035_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				85.27	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	35	0	1	1	1	H1112_035_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	37	0	1	1	1	H1112_037_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	37	0	1	1	1	H1112_037_0	7	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1112	37	0	1	1	1	H1112_037_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	37	0	1	1	1	H1112_037_0	7	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1112	37	0	1	1	1	H1112_037_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	37	0	1	1	1	H1112_037_0	7	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1112	37	0	1	1	1	H1112_037_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				66.09	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	37	0	1	1	1	H1112_037_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	38	0	1	1	1	H1112_038_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	38	0	1	1	1	H1112_038_0	7	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H1112	38	0	1	1	1	H1112_038_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	38	0	1	1	1	H1112_038_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	44		132																									44		132				44		88				44				44		1.47				1.47	1.47	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	38	0	1	1	1	H1112_038_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				90.12	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	38	0	1	1	1	H1112_038_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	39	0	1	1	1	H1112_039_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	39	0	1	1	1	H1112_039_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H1112	39	0	1	1	1	H1112_039_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	39	0	1	1	1	H1112_039_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	44		132																									44		132				44		88				44				44		1.47				1.47	1.47	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	39	0	1	1	1	H1112_039_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				90.12	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	39	0	1	1	1	H1112_039_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	40	0	1	1	1	H1112_040_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	40	0	1	1	1	H1112_040_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1112	40	0	1	1	1	H1112_040_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	40	0	1	1	1	H1112_040_0	6	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1112	40	0	1	1	1	H1112_040_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	44		132																									44		132				44		88				44				44		1.47				1.47	1.47	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	40	0	1	1	1	H1112_040_0	6	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	44		132																									44		132				44		88				44				44		1.47				1.47	1.47	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H1112	40	0	1	1	1	H1112_040_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				87.65	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	40	0	1	1	1	H1112_040_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	42	0	1	1	1	H1112_042_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	4		12																									4		12				4		0				4				4		0.13				0.13	0.13	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	42	0	1	1	1	H1112_042_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	42	0	1	1	1	H1112_042_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	42	0	1	1	1	H1112_042_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				80.31	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	42	0	1	1	1	H1112_042_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	43	0	1	1	1	H1112_043_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	43	0	1	1	1	H1112_043_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	43	0	1	1	1	H1112_043_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	43	0	1	1	1	H1112_043_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	43	0	1	1	1	H1112_043_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	44	0	1	1	1	H1112_044_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	44	0	1	1	1	H1112_044_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	44	0	1	1	1	H1112_044_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	44	0	1	1	1	H1112_044_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				87.72	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1112	44	0	1	1	1	H1112_044_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1142	1	0	1	1	1	H1142_001_0	8	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	1	0	1	1	1	H1142_001_0	8	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		20																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	1	0	1	1	1	H1142_001_0	8	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	1	0	1	1	1	H1142_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	1	0	1	1	1	H1142_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				768.84	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	1	0	1	1	1	H1142_001_0	8	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	1	0	1	1	1	H1142_001_0	8	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1142	2	0	1	1	1	H1142_002_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	2	0	1	1	1	H1142_002_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	2	0	1	1	1	H1142_002_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	2	0	1	1	1	H1142_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	2	0	1	1	1	H1142_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				756.44	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	2	0	1	1	1	H1142_002_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	2	0	1	1	1	H1142_002_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1142	3	0	1	1	1	H1142_003_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	3	0	1	1	1	H1142_003_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	4		8																			4		8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	3	0	1	1	1	H1142_003_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	3	0	1	1	1	H1142_003_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	3	0	1	1	1	H1142_003_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.06	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	3	0	1	1	1	H1142_003_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	3	0	1	1	1	H1142_003_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1142	6	0	1	1	1	H1142_006_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	6	0	1	1	1	H1142_006_0	6	Generic	4	11	1	1	2	1	110		1	110		1	30		90				1	2	30		90				30		31				11.34	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	6	0	1	1	1	H1142_006_0	6	Preferred Brand	4	11	1	1	3	1	110		1	110		1	30		90				1	2	30		90				30		31				61.36	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	6	0	1	1	1	H1142_006_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				1	2	30		90				30		31				78.84	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	6	0	1	1	1	H1142_006_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				676.97	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	6	0	1	1	1	H1142_006_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1142	6	0	1	1	1	H1142_006_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1170	2	0	1	1	1	H1170_002_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	2	0	1	1	1	H1170_002_0	7	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1170	2	0	1	1	1	H1170_002_0	7	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	2	0	1	1	1	H1170_002_0	7	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1170	2	0	1	1	1	H1170_002_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	2	0	1	1	1	H1170_002_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.16			3.16			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	2	0	1	1	1	H1170_002_0	7	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1655	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	2	0	1	1	1	H1170_002_0	7	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	2	0	1	1	1	H1170_002_0	7	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1170	8	0	1	1	1	H1170_008_0	6	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	8	0	1	1	1	H1170_008_0	6	Generic	3	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	8	0	1	1	1	H1170_008_0	6	Preferred Brand	3	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	8	0	1	1	1	H1170_008_0	6	Non-Preferred Brand	3	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	8	0	1	1	1	H1170_008_0	6	Specialty Tier	3	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1669	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	8	0	1	1	1	H1170_008_0	6	Vaccines	3	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	9	0	1	1	1	H1170_009_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	9	0	1	1	1	H1170_009_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1170	9	0	1	1	1	H1170_009_0	6	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	9	0	1	1	1	H1170_009_0	6	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1170	9	0	1	1	1	H1170_009_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	9	0	1	1	1	H1170_009_0	6	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.16			3.16			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	9	0	1	1	1	H1170_009_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1724	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	9	0	1	1	1	H1170_009_0	6	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1170	9	0	1	1	1	H1170_009_0	6	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1189	1	0	1	1	1	H1189_001_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		34	4		12																					0																4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	1	0	1	1	1	H1189_001_0	5	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		34	10		30																					0																10				10		0.32						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	1	0	1	1	1	H1189_001_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	31		90				1	2			90				31		34	35		105																					70																35				35		1.13						1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	1	0	1	1	1	H1189_001_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	31		90				1	2			90				31		34	90		270																					180																90				90		2.9						2.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	1	0	1	1	1	H1189_001_0	5	Specialty Tier	4	11	1	1	5	1	110		1	100		1	31		90				1	2			90				31		34				1255.9	29		29																				29															29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	2	0	1	1	1	H1189_002_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		34	4		12																					0																4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	2	0	1	1	1	H1189_002_0	5	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		34	10		30																					0																10				10		0.32						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	2	0	1	1	1	H1189_002_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	31		90				1	2			90				31		34	35		105																					70																35				35		1.13						1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	2	0	1	1	1	H1189_002_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	31		90				1	2			90				31		34	90		270																					180																90				90		2.9						2.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	2	0	1	1	1	H1189_002_0	5	Specialty Tier	4	11	1	1	5	1	110		1	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"												
H1189	3	0	1	1	1	H1189_003_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		34	4		12																					0																4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	3	0	1	1	1	H1189_003_0	5	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		34	10		30																					0																10				10		0.32						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	3	0	1	1	1	H1189_003_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	31		90				1	2			90				31		34	35		105																					70																35				35		1.13						1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	3	0	1	1	1	H1189_003_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	31		90				1	2			90				31		34	90		270																					180																90				90		2.9						2.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	3	0	1	1	1	H1189_003_0	5	Specialty Tier	4	11	1	1	5	1	110		1	100		1	31		90				1	2			90				31		34				1255.9	29		29																				29															29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	4	0	1	1	1	H1189_004_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		34	4		12																					0																4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	4	0	1	1	1	H1189_004_0	5	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		34	10		30																					0																10				10		0.32						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	4	0	1	1	1	H1189_004_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	31		90				1	2			90				31		34	35		105																					70																35				35		1.13						1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	4	0	1	1	1	H1189_004_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	31		90				1	2			90				31		34	90		270																					180																90				90		2.9						2.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1189	4	0	1	1	1	H1189_004_0	5	Specialty Tier	4	11	1	1	5	1	110		1	100		1	31		90				1	2			90				31		34				1255.9	29		29																				29															29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	1	0	1	1	1	H1225_001_0	9	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	1	0	1	1	1	H1225_001_0	9	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1225	1	0	1	1	1	H1225_001_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	15	20																			10	15	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	1	0	1	1	1	H1225_001_0	9	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	70.5	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	1	0	1	1	1	H1225_001_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	150	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	1	0	1	1	1	H1225_001_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	2	0	1	1	1	H1225_002_0	9	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	2	0	1	1	1	H1225_002_0	9	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1225	2	0	1	1	1	H1225_002_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	15	20																			10	15	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	2	0	1	1	1	H1225_002_0	9	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	70.5	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	2	0	1	1	1	H1225_002_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	150	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1225	2	0	1	1	1	H1225_002_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1230	1	0	1	1	1	H1230_001_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	1	0	1	1	1	H1230_001_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1230	1	0	1	1	1	H1230_001_0	10	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	1	0	1	1	1	H1230_001_0	10	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1230	1	0	1	1	1	H1230_001_0	10	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	1	0	1	1	1	H1230_001_0	10	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	1	0	1	1	1	H1230_001_0	10	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1851	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	1	0	1	1	1	H1230_001_0	10	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	1	0	1	1	1	H1230_001_0	10	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1230	3	0	1	1	1	H1230_003_0	12	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	3	0	1	1	1	H1230_003_0	12	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1230	3	0	1	1	1	H1230_003_0	12	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	3	0	1	1	1	H1230_003_0	12	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1230	3	0	1	1	1	H1230_003_0	12	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	3	0	1	1	1	H1230_003_0	12	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	3	0	1	1	1	H1230_003_0	12	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1564	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	3	0	1	1	1	H1230_003_0	12	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	3	0	1	1	1	H1230_003_0	12	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H1230	13	0	1	1	1	H1230_013_0	10	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	13	0	1	1	1	H1230_013_0	10	Generic	3	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	13	0	1	1	1	H1230_013_0	10	Preferred Brand	3	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	13	0	1	1	1	H1230_013_0	10	Non-Preferred Brand	3	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	13	0	1	1	1	H1230_013_0	10	Specialty Tier	3	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1632	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	13	0	1	1	1	H1230_013_0	10	Vaccines	3	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	14	0	1	1	1	H1230_014_0	11	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	14	0	1	1	1	H1230_014_0	11	Generic	3	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	14	0	1	1	1	H1230_014_0	11	Preferred Brand	3	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	14	0	1	1	1	H1230_014_0	11	Non-Preferred Brand	3	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	14	0	1	1	1	H1230_014_0	11	Specialty Tier	3	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1722	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1230	14	0	1	1	1	H1230_014_0	11	Vaccines	3	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H1248	1	0	1	4	1	H1248_001_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	1	0	1	4	1	H1248_001_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	1	0	1	4	1	H1248_001_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	1	0	1	4	1	H1248_001_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	1	0	1	4	1	H1248_001_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	1	0	1	4	1	H1248_001_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	1	0	1	4	1	H1248_001_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											723.78	33						473.52	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	2	0	1	4	1	H1248_002_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	2	0	1	4	1	H1248_002_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	2	0	1	4	1	H1248_002_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	2	0	1	4	1	H1248_002_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	2	0	1	4	1	H1248_002_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	2	0	1	4	1	H1248_002_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	2	0	1	4	1	H1248_002_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.16	33						475.48	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	3	0	1	4	1	H1248_003_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	3	0	1	4	1	H1248_003_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	3	0	1	4	1	H1248_003_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	3	0	1	4	1	H1248_003_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	3	0	1	4	1	H1248_003_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	3	0	1	4	1	H1248_003_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	3	0	1	4	1	H1248_003_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.59	33						474.14	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	4	0	1	4	1	H1248_004_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	4	0	1	4	1	H1248_004_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	4	0	1	4	1	H1248_004_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	4	0	1	4	1	H1248_004_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	4	0	1	4	1	H1248_004_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	4	0	1	4	1	H1248_004_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	4	0	1	4	1	H1248_004_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.49	33						476.97	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	5	0	1	4	1	H1248_005_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	5	0	1	4	1	H1248_005_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	5	0	1	4	1	H1248_005_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	5	0	1	4	1	H1248_005_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	5	0	1	4	1	H1248_005_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	5	0	1	4	1	H1248_005_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	5	0	1	4	1	H1248_005_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.43	33						476.66	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	6	0	1	4	1	H1248_006_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	6	0	1	4	1	H1248_006_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	6	0	1	4	1	H1248_006_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	6	0	1	4	1	H1248_006_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1248	6	0	1	4	1	H1248_006_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	6	0	1	4	1	H1248_006_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1248	6	0	1	4	1	H1248_006_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.96	33						478.81	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1277	1	0	1	1	1	H1277_001_0	5	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2	4	6																																						2			2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	1	0	1	1	1	H1277_001_0	5	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	1	0	1	1	1	H1277_001_0	5	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	1	0	1	1	1	H1277_001_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	1	0	1	1	1	H1277_001_0	5	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31				775.52	25																																						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	2	0	1	1	1	H1277_002_0	6	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2	4	6																																						2			2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	2	0	1	1	1	H1277_002_0	6	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	2	0	1	1	1	H1277_002_0	6	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	2	0	1	1	1	H1277_002_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1277	2	0	1	1	1	H1277_002_0	6	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31				769.1	25																																						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1278	1	0	1	4	1	H1278_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	1	0	1	4	1	H1278_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	1	0	1	4	1	H1278_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	1	0	1	4	1	H1278_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	1	0	1	4	1	H1278_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				796	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	3	0	1	4	1	H1278_003_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	3	0	1	4	1	H1278_003_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	3	0	1	4	1	H1278_003_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	3	0	1	4	1	H1278_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	3	0	1	4	1	H1278_003_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				747	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	4	0	1	4	1	H1278_004_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	4	0	1	4	1	H1278_004_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1278	4	0	1	4	1	H1278_004_0	5	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	4	0	1	4	1	H1278_004_0	5	Generic	4	1	1	2	2	3		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1278	4	0	1	4	1	H1278_004_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	4	0	1	4	1	H1278_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	4	0	1	4	1	H1278_004_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1069	26		26				663	26		26												26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	5	0	1	4	1	H1278_005_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	5	0	1	4	1	H1278_005_0	5	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	5	0	1	4	1	H1278_005_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	5	0	1	4	1	H1278_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	5	0	1	4	1	H1278_005_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											721	26		26				575	26		26												26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	7	0	1	4	1	H1278_007_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	7	0	1	4	1	H1278_007_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	7	0	1	4	1	H1278_007_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	7	0	1	4	1	H1278_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	7	0	1	4	1	H1278_007_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				906	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	9	0	1	4	1	H1278_009_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	9	0	1	4	1	H1278_009_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	9	0	1	4	1	H1278_009_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	9	0	1	4	1	H1278_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	9	0	1	4	1	H1278_009_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				795	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	10	0	1	4	1	H1278_010_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	10	0	1	4	1	H1278_010_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	10	0	1	4	1	H1278_010_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	10	0	1	4	1	H1278_010_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1278	10	0	1	4	1	H1278_010_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				784	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	2	0	1	1	1	H1286_002_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	2	0	1	1	1	H1286_002_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	2	0	1	1	1	H1286_002_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	2	0	1	1	1	H1286_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	2	0	1	1	1	H1286_002_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1056	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	9	0	1	1	1	H1286_009_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	9	0	1	1	1	H1286_009_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	9	0	1	1	1	H1286_009_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	9	0	1	1	1	H1286_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1286	9	0	1	1	1	H1286_009_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				835	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	1	0	1	1	1	H1290_001_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	1	0	1	1	1	H1290_001_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1290	1	0	1	1	1	H1290_001_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	1	0	1	1	1	H1290_001_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1290	1	0	1	1	1	H1290_001_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	1	0	1	1	1	H1290_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	35	70	105																			35	70	105																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	1	0	1	1	1	H1290_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	2	0	1	1	1	H1290_002_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	2	0	1	1	1	H1290_002_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1290	2	0	1	1	1	H1290_002_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	2	0	1	1	1	H1290_002_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1290	2	0	1	1	1	H1290_002_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	40																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	2	0	1	1	1	H1290_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	85	170	255																			85	170	255																85				85		2.83			2.83			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	2	0	1	1	1	H1290_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				755.96	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	3	0	1	1	1	H1290_003_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	3	0	1	1	1	H1290_003_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1290	3	0	1	1	1	H1290_003_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	3	0	1	1	1	H1290_003_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1290	3	0	1	1	1	H1290_003_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	40																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	3	0	1	1	1	H1290_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	3	0	1	1	1	H1290_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				759.4	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	4	0	1	1	1	H1290_004_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	4	0	1	1	1	H1290_004_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1290	4	0	1	1	1	H1290_004_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	4	0	1	1	1	H1290_004_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1290	4	0	1	1	1	H1290_004_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	4	0	1	1	1	H1290_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	225																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	4	0	1	1	1	H1290_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				752.67	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	5	0	1	1	1	H1290_005_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	5	0	1	1	1	H1290_005_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1290	5	0	1	1	1	H1290_005_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	5	0	1	1	1	H1290_005_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1290	5	0	1	1	1	H1290_005_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	30	60	90																			30	60	60																30				30		1			1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	5	0	1	1	1	H1290_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	85	170	255																			85	170	255																85				85		2.83			2.83			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	5	0	1	1	1	H1290_005_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				751.32	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	6	0	1	1	1	H1290_006_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	6	0	1	1	1	H1290_006_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1290	6	0	1	1	1	H1290_006_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	6	0	1	1	1	H1290_006_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1290	6	0	1	1	1	H1290_006_0	5	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				26.04	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	6	0	1	1	1	H1290_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				45.5	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	6	0	1	1	1	H1290_006_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				521.43	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	7	0	1	1	1	H1290_007_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	7	0	1	1	1	H1290_007_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	7	0	1	1	1	H1290_007_0	5	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				26.2	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	7	0	1	1	1	H1290_007_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				42.64	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	7	0	1	1	1	H1290_007_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				521.95	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	8	0	1	1	1	H1290_008_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	8	0	1	1	1	H1290_008_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	8	0	1	1	1	H1290_008_0	5	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				26.2	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	8	0	1	1	1	H1290_008_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				42.64	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	8	0	1	1	1	H1290_008_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				521.95	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	9	0	1	1	1	H1290_009_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	9	0	1	1	1	H1290_009_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	9	0	1	1	1	H1290_009_0	5	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				26.2	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	9	0	1	1	1	H1290_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				42.64	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	9	0	1	1	1	H1290_009_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				521.95	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	10	0	1	1	1	H1290_010_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	10	0	1	1	1	H1290_010_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	10	0	1	1	1	H1290_010_0	5	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				26.2	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	10	0	1	1	1	H1290_010_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				42.64	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	10	0	1	1	1	H1290_010_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				521.95	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	13	0	1	1	1	H1290_013_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	13	0	1	1	1	H1290_013_0	5	Generic	4	1	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	13	0	1	1	1	H1290_013_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	30	60	90																			30	60	60																30				30		1			1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	13	0	1	1	1	H1290_013_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	85	170	255																			85	170	255																85				85		2.83			2.83			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	13	0	1	1	1	H1290_013_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	14	0	1	1	1	H1290_014_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	14	0	1	1	1	H1290_014_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	14	0	1	1	1	H1290_014_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	14	0	1	1	1	H1290_014_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	14	0	1	1	1	H1290_014_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	15	0	1	1	1	H1290_015_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	15	0	1	1	1	H1290_015_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	15	0	1	1	1	H1290_015_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	15	0	1	1	1	H1290_015_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	15	0	1	1	1	H1290_015_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	16	0	1	1	1	H1290_016_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	16	0	1	1	1	H1290_016_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	16	0	1	1	1	H1290_016_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	16	0	1	1	1	H1290_016_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	16	0	1	1	1	H1290_016_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	17	0	1	1	1	H1290_017_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	17	0	1	1	1	H1290_017_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	17	0	1	1	1	H1290_017_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	17	0	1	1	1	H1290_017_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	17	0	1	1	1	H1290_017_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	18	0	1	1	1	H1290_018_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	18	0	1	1	1	H1290_018_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	18	0	1	1	1	H1290_018_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	18	0	1	1	1	H1290_018_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1290	18	0	1	1	1	H1290_018_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	4	0	1	4	1	H1304_004_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	4	0	1	4	1	H1304_004_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	4	0	1	4	1	H1304_004_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	4	0	1	4	1	H1304_004_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	4	0	1	4	1	H1304_004_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											853.32	33						853.32	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	1	1	4	1	H1304_011_1	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	1	1	4	1	H1304_011_1	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	1	1	4	1	H1304_011_1	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	1	1	4	1	H1304_011_1	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	1	1	4	1	H1304_011_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											698.17	27						698.17	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	2	1	4	1	H1304_011_2	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	2	1	4	1	H1304_011_2	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	2	1	4	1	H1304_011_2	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	2	1	4	1	H1304_011_2	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	11	2	1	4	1	H1304_011_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											698.17	27						698.17	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	1	1	4	1	H1304_012_1	12	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	1	1	4	1	H1304_012_1	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	1	1	4	1	H1304_012_1	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	1	1	4	1	H1304_012_1	12	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	1	1	4	1	H1304_012_1	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	2	1	4	1	H1304_012_2	12	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	2	1	4	1	H1304_012_2	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	2	1	4	1	H1304_012_2	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	2	1	4	1	H1304_012_2	12	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1304	12	2	1	4	1	H1304_012_2	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	1	1	1	1	H1350_015_1	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				0			0.17	0		0.17	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	1	1	1	1	H1350_015_1	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					12	24	36											20	40	60				12	24	36				20				12			0.67	0.4		0.67	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	1	1	1	1	H1350_015_1	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								45	90	135					35	70	105											45	90	135				35	70	105				45				35			1.5	1.17		1.5	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	1	1	1	1	H1350_015_1	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								95	190	285					85	170	255											95	190	285				85	170	255				95				85			3.17	2.83		3.17	2.83	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	1	1	1	1	H1350_015_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	33						990	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	2	1	1	1	H1350_015_2	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				0			0.17	0		0.17	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	2	1	1	1	H1350_015_2	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					12	24	36											20	40	60				12	24	36				20				12			0.67	0.4		0.67	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	2	1	1	1	H1350_015_2	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								45	90	135					35	70	105											45	90	135				35	70	105				45				35			1.5	1.17		1.5	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	2	1	1	1	H1350_015_2	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								95	190	285					85	170	255											95	190	285				85	170	255				95				85			3.17	2.83		3.17	2.83	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	15	2	1	1	1	H1350_015_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	33						990	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	1	1	1	1	H1350_016_1	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	9											10	20	30				3	6	9				10				3			0.33	0.1		0.33	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	1	1	1	1	H1350_016_1	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					12	24	36											20	40	60				12	24	36				20				12			0.67	0.4		0.67	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	1	1	1	1	H1350_016_1	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	111				47				37			1.57	1.23		1.57	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	1	1	1	1	H1350_016_1	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	1	1	1	1	H1350_016_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	28						990	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	2	1	1	1	H1350_016_2	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	9											10	20	30				3	6	9				10				3			0.33	0.1		0.33	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	2	1	1	1	H1350_016_2	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					12	24	36											20	40	60				12	24	36				20				12			0.67	0.4		0.67	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	2	1	1	1	H1350_016_2	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	111				47				37			1.57	1.23		1.57	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	2	1	1	1	H1350_016_2	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	16	2	1	1	1	H1350_016_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	28						990	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	1	1	1	1	H1350_019_1	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					3	6	9											15	30	45				3	6	9				15				3			0.5	0.1		0.5	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	1	1	1	1	H1350_019_1	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					12	24	36											20	40	60				12	24	36				20				12			0.67	0.4		0.67	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	1	1	1	1	H1350_019_1	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					31	62	93											47	94	141				31	62	93				47				31			1.57	1.03		1.57	1.03	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	1	1	1	1	H1350_019_1	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	1	1	1	1	H1350_019_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	31						990	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	2	1	1	1	H1350_019_2	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					3	6	9											15	30	45				3	6	9				15				3			0.5	0.1		0.5	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	2	1	1	1	H1350_019_2	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					12	24	36											20	40	60				12	24	36				20				12			0.67	0.4		0.67	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	2	1	1	1	H1350_019_2	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					31	62	93											47	94	141				31	62	93				47				31			1.57	1.03		1.57	1.03	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	2	1	1	1	H1350_019_2	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	19	2	1	1	1	H1350_019_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	31						990	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	21	0	1	1	1	H1350_021_0	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				0			0.5	0		0.5	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	21	0	1	1	1	H1350_021_0	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	18				20				6			0.67	0.2		0.67	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	21	0	1	1	1	H1350_021_0	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					31	62	93											47	94	141				31	62	93				47				31			1.57	1.03		1.57	1.03	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	21	0	1	1	1	H1350_021_0	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	21	0	1	1	1	H1350_021_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	30						990	30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	1	1	1	1	H1350_022_1	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				0			0.5	0		0.5	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	1	1	1	1	H1350_022_1	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	18				20				6			0.67	0.2		0.67	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	1	1	1	1	H1350_022_1	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					31	62	93											47	94	141				31	62	93				47				31			1.57	1.03		1.57	1.03	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	1	1	1	1	H1350_022_1	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	1	1	1	1	H1350_022_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	30						990	30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	2	1	1	1	H1350_022_2	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				0			0.5	0		0.5	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	2	1	1	1	H1350_022_2	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	18				20				6			0.67	0.2		0.67	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	2	1	1	1	H1350_022_2	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					31	62	93											47	94	141				31	62	93				47				31			1.57	1.03		1.57	1.03	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	2	1	1	1	H1350_022_2	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	22	2	1	1	1	H1350_022_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	30						990	30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	1	1	1	1	H1350_023_1	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				0			0.17	0		0.17	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	1	1	1	1	H1350_023_1	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					6	12	18											15	30	45				6	12	18				15				6			0.5	0.2		0.5	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	1	1	1	1	H1350_023_1	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					31	62	93											47	94	141				31	62	93				47				31			1.57	1.03		1.57	1.03	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	1	1	1	1	H1350_023_1	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	1	1	1	1	H1350_023_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	29						990	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	2	1	1	1	H1350_023_2	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				0			0.17	0		0.17	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	2	1	1	1	H1350_023_2	3	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					6	12	18											15	30	45				6	12	18				15				6			0.5	0.2		0.5	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	2	1	1	1	H1350_023_2	3	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					31	62	93											47	94	141				31	62	93				47				31			1.57	1.03		1.57	1.03	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	2	1	1	1	H1350_023_2	3	Non-Preferred Drug	4	10	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					90	180	270											100	200	300				90	180	270				100				90			3.33	3		3.33	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1350	23	2	1	1	1	H1350_023_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											990	29						990	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1352	1	0	1	1	1	H1352_001_0	16	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	0																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	1	0	1	1	1	H1352_001_0	16	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	0																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	1	0	1	1	1	H1352_001_0	16	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	1	0	1	1	1	H1352_001_0	16	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	1	0	1	1	1	H1352_001_0	16	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				0	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	2	0	1	1	1	H1352_002_0	16	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	0																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	2	0	1	1	1	H1352_002_0	16	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	0																					0																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	2	0	1	1	1	H1352_002_0	16	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	2	0	1	1	1	H1352_002_0	16	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1352	2	0	1	1	1	H1352_002_0	16	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				0	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1353	1	0	1	1	1	H1353_001_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	1	0	1	1	1	H1353_001_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	1	0	1	1	1	H1353_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	1	0	1	1	1	H1353_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				82.49	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	1	0	1	1	1	H1353_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	2	0	1	1	1	H1353_002_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	2	0	1	1	1	H1353_002_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	2	0	1	1	1	H1353_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	2	0	1	1	1	H1353_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.37	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	2	0	1	1	1	H1353_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	3	0	1	1	1	H1353_003_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	3	0	1	1	1	H1353_003_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	3	0	1	1	1	H1353_003_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	3	0	1	1	1	H1353_003_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.37	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	3	0	1	1	1	H1353_003_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	4	0	1	1	1	H1353_004_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	4	0	1	1	1	H1353_004_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	4	0	1	1	1	H1353_004_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	4	0	1	1	1	H1353_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.37	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	4	0	1	1	1	H1353_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	5	0	1	1	1	H1353_005_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	5	0	1	1	1	H1353_005_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	5	0	1	1	1	H1353_005_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	5	0	1	1	1	H1353_005_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				82.49	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1353	5	0	1	1	1	H1353_005_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	1	0	1	4	1	H1365_001_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	1	0	1	4	1	H1365_001_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	1	0	1	4	1	H1365_001_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	1	0	1	4	1	H1365_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	1	0	1	4	1	H1365_001_0	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	2	0	1	4	1	H1365_002_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	2	0	1	4	1	H1365_002_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	2	0	1	4	1	H1365_002_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	2	0	1	4	1	H1365_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1365	2	0	1	4	1	H1365_002_0	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1393	1	0	1	4	1	H1393_001_0	7	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	1	0	1	4	1	H1393_001_0	7	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	1	0	1	4	1	H1393_001_0	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	1	0	1	4	1	H1393_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	1	0	1	4	1	H1393_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											769.93	33						769.93	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	1	0	1	4	1	H1393_001_0	7	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	1	0	1	4	1	H1393_001_0	7	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1393	2	0	1	4	1	H1393_002_0	7	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	2	0	1	4	1	H1393_002_0	7	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	2	0	1	4	1	H1393_002_0	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	2	0	1	4	1	H1393_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	2	0	1	4	1	H1393_002_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											751.77	33						751.77	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	2	0	1	4	1	H1393_002_0	7	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	2	0	1	4	1	H1393_002_0	7	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1393	3	0	1	4	1	H1393_003_0	7	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	3	0	1	4	1	H1393_003_0	7	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	3	0	1	4	1	H1393_003_0	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	3	0	1	4	1	H1393_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	3	0	1	4	1	H1393_003_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											771.37	33						771.37	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	3	0	1	4	1	H1393_003_0	7	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	3	0	1	4	1	H1393_003_0	7	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1393	4	0	1	4	1	H1393_004_0	7	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	4	0	1	4	1	H1393_004_0	7	Generic	4	11	1	1	2	1		110	1	110		1				30		90	1	2	30		90				30		31											10.74	25		25				10.74	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	4	0	1	4	1	H1393_004_0	7	Preferred Brand	4	11	1	1	3	1		110	1	110		1				30		90	1	2	30		90				30		31											60.88	25		25				60.88	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	4	0	1	4	1	H1393_004_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											76.96	25		25				76.96	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	4	0	1	4	1	H1393_004_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											675.83	25						675.83	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	4	0	1	4	1	H1393_004_0	7	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1393	4	0	1	4	1	H1393_004_0	7	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1415	21	0	1	2	1	H1415_021_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	10					0	0	0											5	10	10				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	21	0	1	2	1	H1415_021_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	18					4	8	8											9	18	18				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	21	0	1	2	1	H1415_021_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	21	0	1	2	1	H1415_021_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											84.04	48	48	48				84.73	45	45	45										48	48	48				45	45	45			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	21	0	1	2	1	H1415_021_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											907.65	33						1016.93	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	24	0	1	1	1	H1415_024_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	10					0	0	0											5	10	10				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	24	0	1	1	1	H1415_024_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	18					4	8	8											9	18	18				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	24	0	1	1	1	H1415_024_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	24	0	1	1	1	H1415_024_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.57	47	47	47				92.04	45	45	45										47	47	47				45	45	45			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1415	24	0	1	1	1	H1415_024_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											777.9	33						871.05	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	9	0	1	2	1	H1416_009_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	9	0	1	2	1	H1416_009_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	9	0	1	2	1	H1416_009_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	9	0	1	2	1	H1416_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				75.22	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	9	0	1	2	1	H1416_009_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	23	0	1	1	1	H1416_023_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	23	0	1	1	1	H1416_023_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	23	0	1	1	1	H1416_023_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	23	0	1	1	1	H1416_023_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				84.36	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	23	0	1	1	1	H1416_023_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	24	0	1	2	1	H1416_024_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	24	0	1	2	1	H1416_024_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H1416	24	0	1	2	1	H1416_024_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	24	0	1	2	1	H1416_024_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	24	0	1	2	1	H1416_024_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				76.43	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	24	0	1	2	1	H1416_024_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	26	0	1	2	1	H1416_026_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	26	0	1	2	1	H1416_026_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	26	0	1	2	1	H1416_026_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	26	0	1	2	1	H1416_026_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	26	0	1	2	1	H1416_026_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	31	0	1	2	1	H1416_031_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	31	0	1	2	1	H1416_031_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	31	0	1	2	1	H1416_031_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	31	0	1	2	1	H1416_031_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	31	0	1	2	1	H1416_031_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	32	0	1	2	1	H1416_032_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	32	0	1	2	1	H1416_032_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	32	0	1	2	1	H1416_032_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	32	0	1	2	1	H1416_032_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	32	0	1	2	1	H1416_032_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	33	0	1	2	1	H1416_033_0	6	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	33	0	1	2	1	H1416_033_0	6	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	33	0	1	2	1	H1416_033_0	6	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	33	0	1	2	1	H1416_033_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.33	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	33	0	1	2	1	H1416_033_0	6	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	34	0	1	1	1	H1416_034_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	34	0	1	1	1	H1416_034_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	34	0	1	1	1	H1416_034_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	34	0	1	1	1	H1416_034_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.86	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	34	0	1	1	1	H1416_034_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	35	0	1	1	1	H1416_035_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	35	0	1	1	1	H1416_035_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	14		42																									14		42				14		0				14				14		0.47				0.47	0.47	0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	35	0	1	1	1	H1416_035_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	35	0	1	1	1	H1416_035_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.67	44		44																								44		44				44		44			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	35	0	1	1	1	H1416_035_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	36	0	1	1	1	H1416_036_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	36	0	1	1	1	H1416_036_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	36	0	1	1	1	H1416_036_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	36	0	1	1	1	H1416_036_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.63	44		44																								44		44				44		44			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	36	0	1	1	1	H1416_036_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	38	0	1	1	1	H1416_038_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	38	0	1	1	1	H1416_038_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	38	0	1	1	1	H1416_038_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	38	0	1	1	1	H1416_038_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				87.28	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	38	0	1	1	1	H1416_038_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					26																										26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	39	0	1	1	1	H1416_039_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	39	0	1	1	1	H1416_039_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	39	0	1	1	1	H1416_039_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	39	0	1	1	1	H1416_039_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	39	0	1	1	1	H1416_039_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	41	0	1	1	1	H1416_041_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	41	0	1	1	1	H1416_041_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	41	0	1	1	1	H1416_041_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	41	0	1	1	1	H1416_041_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				91.05	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	41	0	1	1	1	H1416_041_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	42	0	1	1	1	H1416_042_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	42	0	1	1	1	H1416_042_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	42	0	1	1	1	H1416_042_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	42	0	1	1	1	H1416_042_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.5	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	42	0	1	1	1	H1416_042_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	43	0	1	2	1	H1416_043_0	6	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	43	0	1	2	1	H1416_043_0	6	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	43	0	1	2	1	H1416_043_0	6	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	43	0	1	2	1	H1416_043_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.82	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	43	0	1	2	1	H1416_043_0	6	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	44	0	1	1	1	H1416_044_0	6	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	44	0	1	1	1	H1416_044_0	6	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	44	0	1	1	1	H1416_044_0	6	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	44	0	1	1	1	H1416_044_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				96.42	46		46																								46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	44	0	1	1	1	H1416_044_0	6	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	48	0	1	1	1	H1416_048_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	48	0	1	1	1	H1416_048_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	48	0	1	1	1	H1416_048_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	48	0	1	1	1	H1416_048_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				83.87	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	48	0	1	1	1	H1416_048_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	55	0	1	1	1	H1416_055_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	55	0	1	1	1	H1416_055_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	55	0	1	1	1	H1416_055_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	55	0	1	1	1	H1416_055_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	55	0	1	1	1	H1416_055_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	56	0	1	1	1	H1416_056_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	56	0	1	1	1	H1416_056_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	56	0	1	1	1	H1416_056_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	56	0	1	1	1	H1416_056_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				83.49	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	56	0	1	1	1	H1416_056_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	57	0	1	1	1	H1416_057_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	57	0	1	1	1	H1416_057_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	57	0	1	1	1	H1416_057_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	57	0	1	1	1	H1416_057_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				83.48	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	57	0	1	1	1	H1416_057_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	62	0	1	1	1	H1416_062_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	62	0	1	1	1	H1416_062_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	62	0	1	1	1	H1416_062_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	62	0	1	1	1	H1416_062_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.95	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	62	0	1	1	1	H1416_062_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	63	0	1	1	1	H1416_063_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	63	0	1	1	1	H1416_063_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	63	0	1	1	1	H1416_063_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	63	0	1	1	1	H1416_063_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.95	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	63	0	1	1	1	H1416_063_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	64	0	1	1	1	H1416_064_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	64	0	1	1	1	H1416_064_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	64	0	1	1	1	H1416_064_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	64	0	1	1	1	H1416_064_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	64	0	1	1	1	H1416_064_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	65	0	1	1	1	H1416_065_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	65	0	1	1	1	H1416_065_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	65	0	1	1	1	H1416_065_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	65	0	1	1	1	H1416_065_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	65	0	1	1	1	H1416_065_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					26																										26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	66	0	1	1	1	H1416_066_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	66	0	1	1	1	H1416_066_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1416	66	0	1	1	1	H1416_066_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	66	0	1	1	1	H1416_066_0	5	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1416	66	0	1	1	1	H1416_066_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	66	0	1	1	1	H1416_066_0	5	Preferred Brand	4	11	3	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	3
H1416	66	0	1	1	1	H1416_066_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1416	66	0	1	1	1	H1416_066_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1426	1	0	1	1	1	H1426_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	1	0	1	1	1	H1426_001_0	3	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H1426	1	0	1	1	1	H1426_001_0	3	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	2			90				30		31	5		10																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	1	0	1	1	1	H1426_001_0	3	Generic	4	1	3	2	2	3	110		1	100		1	30		90				2	2			90				30		31	5		10																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		3
H1426	1	0	1	1	1	H1426_001_0	3	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	35		70																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	1	0	1	1	1	H1426_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	90		180																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	1	0	1	1	1	H1426_001_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				889.09	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	1	0	1	1	1	H1426_001_0	3	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	2	0	1	1	1	H1426_002_0	3	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	2	0	1	1	1	H1426_002_0	3	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H1426	2	0	1	1	1	H1426_002_0	3	Generic	4	1	3	2	2	1	110		1	100		1	30		90				2	2			90				30		31	3		6																					6																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	2	0	1	1	1	H1426_002_0	3	Generic	4	1	3	2	2	3	110		1	100		1	30		90				2	2			90				30		31	3		6																					6																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		3
H1426	2	0	1	1	1	H1426_002_0	3	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	25		50																					50																25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	2	0	1	1	1	H1426_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	85		170																					170																85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	2	0	1	1	1	H1426_002_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				908.12	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	2	0	1	1	1	H1426_002_0	3	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	3	0	1	1	1	H1426_003_0	3	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	3	0	1	1	1	H1426_003_0	3	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H1426	3	0	1	1	1	H1426_003_0	3	Generic	4	1	3	1	2	1	110		1	100		1	30		90				2	2			90				30		31				6.22	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	3	0	1	1	1	H1426_003_0	3	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				96.67	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	3	0	1	1	1	H1426_003_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				45.93	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	3	0	1	1	1	H1426_003_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				723.16	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1426	3	0	1	1	1	H1426_003_0	3	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H1436	2	0	1	1	1	H1436_002_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	2	0	1	1	1	H1436_002_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	36																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	2	0	1	1	1	H1436_002_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	2	0	1	1	1	H1436_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	2	0	1	1	1	H1436_002_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	2	0	1	1	1	H1436_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	4	0	1	1	1	H1436_004_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	4	0	1	1	1	H1436_004_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	24																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	4	0	1	1	1	H1436_004_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	4	0	1	1	1	H1436_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	4	0	1	1	1	H1436_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1436	4	0	1	1	1	H1436_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1463	3	0	1	1	1	H1463_003_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	3	0	1	1	1	H1463_003_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	3	0	1	1	1	H1463_003_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	3	0	1	1	1	H1463_003_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											26.33	50	50	50				33.66	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	3	0	1	1	1	H1463_003_0	9	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	9	0	1	1	1	H1463_009_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	9	0	1	1	1	H1463_009_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	9	0	1	1	1	H1463_009_0	11	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	9	0	1	1	1	H1463_009_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											35.42	50	50	50				43.31	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	9	0	1	1	1	H1463_009_0	11	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	10	0	1	1	1	H1463_010_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	10	0	1	1	1	H1463_010_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	10	0	1	1	1	H1463_010_0	10	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	10	0	1	1	1	H1463_010_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											25.69	50	50	50				33.87	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	10	0	1	1	1	H1463_010_0	10	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	12	0	1	1	1	H1463_012_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	12	0	1	1	1	H1463_012_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	12	0	1	1	1	H1463_012_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	12	0	1	1	1	H1463_012_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											22.51	50	50	50				28.87	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	12	0	1	1	1	H1463_012_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	13	0	1	1	1	H1463_013_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	13	0	1	1	1	H1463_013_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	13	0	1	1	1	H1463_013_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	13	0	1	1	1	H1463_013_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											26.58	50	50	50				34.92	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	13	0	1	1	1	H1463_013_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	15	0	1	2	1	H1463_015_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	15	0	1	2	1	H1463_015_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	15	0	1	2	1	H1463_015_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	15	0	1	2	1	H1463_015_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											26.18	50	50	50				33.67	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	15	0	1	2	1	H1463_015_0	9	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	17	0	1	2	1	H1463_017_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	17	0	1	2	1	H1463_017_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	17	0	1	2	1	H1463_017_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	17	0	1	2	1	H1463_017_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											28.52	50	50	50				37.22	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	17	0	1	2	1	H1463_017_0	9	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	19	0	1	2	1	H1463_019_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	19	0	1	2	1	H1463_019_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	19	0	1	2	1	H1463_019_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	19	0	1	2	1	H1463_019_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.3	50	50	50				47.12	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	19	0	1	2	1	H1463_019_0	9	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	21	0	1	1	1	H1463_021_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	21	0	1	1	1	H1463_021_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	21	0	1	1	1	H1463_021_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	21	0	1	1	1	H1463_021_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											35.75	50	50	50				42.22	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	21	0	1	1	1	H1463_021_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	22	0	1	2	1	H1463_022_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	22	0	1	2	1	H1463_022_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	22	0	1	2	1	H1463_022_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	22	0	1	2	1	H1463_022_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											22.92	50	50	50				30.05	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	22	0	1	2	1	H1463_022_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	23	0	1	1	1	H1463_023_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	12.5					0	0	0					5	10	12.5																5				5			0.17	0	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	23	0	1	1	1	H1463_023_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	37.5					15	30	30					15	30	37.5																15				15			0.5	0.5	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	23	0	1	1	1	H1463_023_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					47	94	94					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	23	0	1	1	1	H1463_023_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											27.63	50	50	50				35.05	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	23	0	1	1	1	H1463_023_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	24	0	1	1	1	H1463_024_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	12.5					0	0	0					5	10	12.5																5				5			0.17	0	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	24	0	1	1	1	H1463_024_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	37.5					15	30	30					15	30	37.5																15				15			0.5	0.5	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	24	0	1	1	1	H1463_024_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					47	94	94					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	24	0	1	1	1	H1463_024_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											25.64	50	50	50				33.22	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	24	0	1	1	1	H1463_024_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	25	0	1	2	1	H1463_025_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	12.5					0	0	0					5	10	12.5																5				5			0.17	0	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	25	0	1	2	1	H1463_025_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	37.5					15	30	30					15	30	37.5																15				15			0.5	0.5	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	25	0	1	2	1	H1463_025_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					47	94	94					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	25	0	1	2	1	H1463_025_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											24.08	50	50	50				31.75	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	25	0	1	2	1	H1463_025_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	32	0	1	1	1	H1463_032_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	12.5					0	0	0					5	10	12.5																5				5			0.17	0	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	32	0	1	1	1	H1463_032_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	37.5					15	30	30					15	30	37.5																15				15			0.5	0.5	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	32	0	1	1	1	H1463_032_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					47	94	94					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	32	0	1	1	1	H1463_032_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											27.48	50	50	50				34.92	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	32	0	1	1	1	H1463_032_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	33	0	1	1	1	H1463_033_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	12.5					0	0	0					5	10	12.5																5				5			0.17	0	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	33	0	1	1	1	H1463_033_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	37.5					15	30	30					15	30	37.5																15				15			0.5	0.5	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	33	0	1	1	1	H1463_033_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					47	94	94					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	33	0	1	1	1	H1463_033_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											27.64	50	50	50				35.07	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	33	0	1	1	1	H1463_033_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	34	0	1	2	1	H1463_034_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	12.5					0	0	0					5	10	12.5																5				5			0.17	0	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	34	0	1	2	1	H1463_034_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	37.5					15	30	30					15	30	37.5																15				15			0.5	0.5	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	34	0	1	2	1	H1463_034_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					47	94	94					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	34	0	1	2	1	H1463_034_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											25.38	50	50	50				32.97	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	34	0	1	2	1	H1463_034_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	35	0	1	1	1	H1463_035_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	35	0	1	1	1	H1463_035_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	35	0	1	1	1	H1463_035_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	35	0	1	1	1	H1463_035_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											28.08	50	50	50				35.49	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	35	0	1	1	1	H1463_035_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	36	0	1	2	1	H1463_036_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	36	0	1	2	1	H1463_036_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	36	0	1	2	1	H1463_036_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	36	0	1	2	1	H1463_036_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											28.08	50	50	50				35.49	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	36	0	1	2	1	H1463_036_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	37	0	1	2	1	H1463_037_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	37	0	1	2	1	H1463_037_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	37	0	1	2	1	H1463_037_0	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	37	0	1	2	1	H1463_037_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											28.08	50	50	50				35.49	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	37	0	1	2	1	H1463_037_0	8	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1463	38	0	1	1	1	H1463_038_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	38	0	1	1	1	H1463_038_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	38	0	1	1	1	H1463_038_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	38	0	1	1	1	H1463_038_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											28.08	50	50	50				35.49	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1463	38	0	1	1	1	H1463_038_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1468	7	0	1	1	1	H1468_007_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	7	0	1	1	1	H1468_007_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	7	0	1	1	1	H1468_007_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	7	0	1	1	1	H1468_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	7	0	1	1	1	H1468_007_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	13	0	1	1	1	H1468_013_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	13	0	1	1	1	H1468_013_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	13	0	1	1	1	H1468_013_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	13	0	1	1	1	H1468_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	13	0	1	1	1	H1468_013_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	14	0	1	1	1	H1468_014_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	14	0	1	1	1	H1468_014_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	14	0	1	1	1	H1468_014_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	14	0	1	1	1	H1468_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	14	0	1	1	1	H1468_014_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	17	0	1	1	1	H1468_017_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1468	17	0	1	1	1	H1468_017_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1468	17	0	1	1	1	H1468_017_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1468	17	0	1	1	1	H1468_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1468	17	0	1	1	1	H1468_017_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1468	17	0	1	1	1	H1468_017_0	3	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1468	18	0	1	1	1	H1468_018_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	18	0	1	1	1	H1468_018_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	18	0	1	1	1	H1468_018_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	18	0	1	1	1	H1468_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1468	18	0	1	1	1	H1468_018_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1475	1	0	1	1	1	H1475_001_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1475	1	0	1	1	1	H1475_001_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					6	12	18					6	12	18																15				15			0.5	0.2	0.2			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1475	1	0	1	1	1	H1475_001_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					39	78	117					39	78	117																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1475	1	0	1	1	1	H1475_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								99	198	297					85	170	255					85	170	255																99				99			3.3	2.83	2.83			3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1475	1	0	1	1	1	H1475_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1475	1	0	1	1	1	H1475_001_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1537	4	0	1	4	1	H1537_004_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1537	4	0	1	4	1	H1537_004_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1537	4	0	1	4	1	H1537_004_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1537	4	0	1	4	1	H1537_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1537	4	0	1	4	1	H1537_004_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				688	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1607	12	0	1	4	1	H1607_012_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	12	0	1	4	1	H1607_012_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	24	24																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	12	0	1	4	1	H1607_012_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	12	0	1	4	1	H1607_012_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	12	0	1	4	1	H1607_012_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	12	0	1	4	1	H1607_012_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	12	0	1	4	1	H1607_012_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1607	14	0	1	4	1	H1607_014_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	14	0	1	4	1	H1607_014_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								18	36	54					13	26	39					13	26	26																18				18			0.6	0.43	0.43			0.53	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	14	0	1	4	1	H1607_014_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	14	0	1	4	1	H1607_014_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	14	0	1	4	1	H1607_014_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	14	0	1	4	1	H1607_014_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1607	14	0	1	4	1	H1607_014_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1608	1	0	1	4	1	H1608_001_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	1	0	1	4	1	H1608_001_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	1	0	1	4	1	H1608_001_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	1	0	1	4	1	H1608_001_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	1	0	1	4	1	H1608_001_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	1	0	1	4	1	H1608_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	1	0	1	4	1	H1608_001_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											844.24	33						899.47	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	4	0	1	4	1	H1608_004_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	4	0	1	4	1	H1608_004_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	4	0	1	4	1	H1608_004_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	4	0	1	4	1	H1608_004_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	4	0	1	4	1	H1608_004_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	4	0	1	4	1	H1608_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	4	0	1	4	1	H1608_004_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											896.7	33						873.83	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	7	0	1	4	1	H1608_007_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	7	0	1	4	1	H1608_007_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	7	0	1	4	1	H1608_007_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	7	0	1	4	1	H1608_007_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	7	0	1	4	1	H1608_007_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	7	0	1	4	1	H1608_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	7	0	1	4	1	H1608_007_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											853.98	33						825.11	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	8	0	1	4	1	H1608_008_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	8	0	1	4	1	H1608_008_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	8	0	1	4	1	H1608_008_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	8	0	1	4	1	H1608_008_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	8	0	1	4	1	H1608_008_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	8	0	1	4	1	H1608_008_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	8	0	1	4	1	H1608_008_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											657.5	33						637.03	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	12	0	1	4	1	H1608_012_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	12	0	1	4	1	H1608_012_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	12	0	1	4	1	H1608_012_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	12	0	1	4	1	H1608_012_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	12	0	1	4	1	H1608_012_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	12	0	1	4	1	H1608_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	12	0	1	4	1	H1608_012_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											688.49	33						629.41	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	13	0	1	4	1	H1608_013_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	13	0	1	4	1	H1608_013_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	13	0	1	4	1	H1608_013_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	13	0	1	4	1	H1608_013_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	13	0	1	4	1	H1608_013_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	13	0	1	4	1	H1608_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	13	0	1	4	1	H1608_013_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											805.16	29						713.73	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	16	0	1	4	1	H1608_016_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	16	0	1	4	1	H1608_016_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	16	0	1	4	1	H1608_016_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	16	0	1	4	1	H1608_016_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	16	0	1	4	1	H1608_016_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	16	0	1	4	1	H1608_016_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	16	0	1	4	1	H1608_016_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				719.42	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	17	0	1	4	1	H1608_017_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	17	0	1	4	1	H1608_017_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	17	0	1	4	1	H1608_017_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	17	0	1	4	1	H1608_017_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	17	0	1	4	1	H1608_017_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	17	0	1	4	1	H1608_017_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	17	0	1	4	1	H1608_017_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				757.26	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	18	0	1	4	1	H1608_018_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	18	0	1	4	1	H1608_018_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	18	0	1	4	1	H1608_018_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	18	0	1	4	1	H1608_018_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	18	0	1	4	1	H1608_018_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	18	0	1	4	1	H1608_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	18	0	1	4	1	H1608_018_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				754.14	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	21	0	1	4	1	H1608_021_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	21	0	1	4	1	H1608_021_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	21	0	1	4	1	H1608_021_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	21	0	1	4	1	H1608_021_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	21	0	1	4	1	H1608_021_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	21	0	1	4	1	H1608_021_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	21	0	1	4	1	H1608_021_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				719.93	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	24	0	1	4	1	H1608_024_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	24	0	1	4	1	H1608_024_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	24	0	1	4	1	H1608_024_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	24	0	1	4	1	H1608_024_0	5	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	24	0	1	4	1	H1608_024_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	24	0	1	4	1	H1608_024_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	24	0	1	4	1	H1608_024_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				664.99	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	26	0	1	4	1	H1608_026_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	26	0	1	4	1	H1608_026_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	26	0	1	4	1	H1608_026_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	26	0	1	4	1	H1608_026_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	26	0	1	4	1	H1608_026_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	26	0	1	4	1	H1608_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	26	0	1	4	1	H1608_026_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											859.09	33						852.49	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	27	0	1	4	1	H1608_027_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	27	0	1	4	1	H1608_027_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	27	0	1	4	1	H1608_027_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	27	0	1	4	1	H1608_027_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	27	0	1	4	1	H1608_027_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	27	0	1	4	1	H1608_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	27	0	1	4	1	H1608_027_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											824.51	33						869.64	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	28	0	1	4	1	H1608_028_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	28	0	1	4	1	H1608_028_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	28	0	1	4	1	H1608_028_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	28	0	1	4	1	H1608_028_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	28	0	1	4	1	H1608_028_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	28	0	1	4	1	H1608_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	28	0	1	4	1	H1608_028_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											801.58	29						780.16	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	29	0	1	4	1	H1608_029_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	29	0	1	4	1	H1608_029_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	29	0	1	4	1	H1608_029_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	29	0	1	4	1	H1608_029_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	29	0	1	4	1	H1608_029_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	29	0	1	4	1	H1608_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	29	0	1	4	1	H1608_029_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											868.57	30						850.89	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	31	0	1	4	1	H1608_031_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	31	0	1	4	1	H1608_031_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	31	0	1	4	1	H1608_031_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	31	0	1	4	1	H1608_031_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	31	0	1	4	1	H1608_031_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	31	0	1	4	1	H1608_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	31	0	1	4	1	H1608_031_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											655.86	29						628.8	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	35	0	1	4	1	H1608_035_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	35	0	1	4	1	H1608_035_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	35	0	1	4	1	H1608_035_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	35	0	1	4	1	H1608_035_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	35	0	1	4	1	H1608_035_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	35	0	1	4	1	H1608_035_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	35	0	1	4	1	H1608_035_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											684.5	29						648.07	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	36	0	1	4	1	H1608_036_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	36	0	1	4	1	H1608_036_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	36	0	1	4	1	H1608_036_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	36	0	1	4	1	H1608_036_0	5	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	36	0	1	4	1	H1608_036_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	36	0	1	4	1	H1608_036_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	36	0	1	4	1	H1608_036_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				692.52	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	37	0	1	4	1	H1608_037_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	37	0	1	4	1	H1608_037_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	37	0	1	4	1	H1608_037_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	37	0	1	4	1	H1608_037_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	37	0	1	4	1	H1608_037_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	37	0	1	4	1	H1608_037_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	37	0	1	4	1	H1608_037_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											782.19	33						787.3	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	38	0	1	4	1	H1608_038_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	38	0	1	4	1	H1608_038_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	38	0	1	4	1	H1608_038_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	38	0	1	4	1	H1608_038_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	38	0	1	4	1	H1608_038_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	38	0	1	4	1	H1608_038_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	38	0	1	4	1	H1608_038_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											757.42	33						717.59	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	39	0	1	4	1	H1608_039_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	39	0	1	4	1	H1608_039_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	39	0	1	4	1	H1608_039_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	39	0	1	4	1	H1608_039_0	5	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	39	0	1	4	1	H1608_039_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	39	0	1	4	1	H1608_039_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	39	0	1	4	1	H1608_039_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				777.8	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	40	0	1	4	1	H1608_040_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	40	0	1	4	1	H1608_040_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	40	0	1	4	1	H1608_040_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	40	0	1	4	1	H1608_040_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	40	0	1	4	1	H1608_040_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	40	0	1	4	1	H1608_040_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	40	0	1	4	1	H1608_040_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											835.55	33						836.54	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	41	0	1	4	1	H1608_041_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	41	0	1	4	1	H1608_041_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	41	0	1	4	1	H1608_041_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	41	0	1	4	1	H1608_041_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	41	0	1	4	1	H1608_041_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	41	0	1	4	1	H1608_041_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	41	0	1	4	1	H1608_041_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											771.71	33						728.54	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	43	0	1	4	1	H1608_043_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	43	0	1	4	1	H1608_043_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	43	0	1	4	1	H1608_043_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	43	0	1	4	1	H1608_043_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	43	0	1	4	1	H1608_043_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	43	0	1	4	1	H1608_043_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	43	0	1	4	1	H1608_043_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											743.54	33						700.93	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	47	0	1	4	1	H1608_047_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	47	0	1	4	1	H1608_047_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	47	0	1	4	1	H1608_047_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	47	0	1	4	1	H1608_047_0	5	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	47	0	1	4	1	H1608_047_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	47	0	1	4	1	H1608_047_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	47	0	1	4	1	H1608_047_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				777.77	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	48	0	1	4	1	H1608_048_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	48	0	1	4	1	H1608_048_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	48	0	1	4	1	H1608_048_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	48	0	1	4	1	H1608_048_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	48	0	1	4	1	H1608_048_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	48	0	1	4	1	H1608_048_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	48	0	1	4	1	H1608_048_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											743.54	33						700.93	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	50	0	1	4	1	H1608_050_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	50	0	1	4	1	H1608_050_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	50	0	1	4	1	H1608_050_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	50	0	1	4	1	H1608_050_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	50	0	1	4	1	H1608_050_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	50	0	1	4	1	H1608_050_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	50	0	1	4	1	H1608_050_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											748.79	33						707.66	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	51	0	1	4	1	H1608_051_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	51	0	1	4	1	H1608_051_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	51	0	1	4	1	H1608_051_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	51	0	1	4	1	H1608_051_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	51	0	1	4	1	H1608_051_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	51	0	1	4	1	H1608_051_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	51	0	1	4	1	H1608_051_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											686.54	30						649.31	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	52	0	1	4	1	H1608_052_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	52	0	1	4	1	H1608_052_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	52	0	1	4	1	H1608_052_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	52	0	1	4	1	H1608_052_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	52	0	1	4	1	H1608_052_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	52	0	1	4	1	H1608_052_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	52	0	1	4	1	H1608_052_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				778.58	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	53	0	1	4	1	H1608_053_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	53	0	1	4	1	H1608_053_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	53	0	1	4	1	H1608_053_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	53	0	1	4	1	H1608_053_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	53	0	1	4	1	H1608_053_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	53	0	1	4	1	H1608_053_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	53	0	1	4	1	H1608_053_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				774.39	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	54	0	1	4	1	H1608_054_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	54	0	1	4	1	H1608_054_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	54	0	1	4	1	H1608_054_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	54	0	1	4	1	H1608_054_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	54	0	1	4	1	H1608_054_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	54	0	1	4	1	H1608_054_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	54	0	1	4	1	H1608_054_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				775.14	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	55	0	1	4	1	H1608_055_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	55	0	1	4	1	H1608_055_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	55	0	1	4	1	H1608_055_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	55	0	1	4	1	H1608_055_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	55	0	1	4	1	H1608_055_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	55	0	1	4	1	H1608_055_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	55	0	1	4	1	H1608_055_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											748.89	33						707.73	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	56	0	1	4	1	H1608_056_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	56	0	1	4	1	H1608_056_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	56	0	1	4	1	H1608_056_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	56	0	1	4	1	H1608_056_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1608	56	0	1	4	1	H1608_056_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	56	0	1	4	1	H1608_056_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1608	56	0	1	4	1	H1608_056_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											678.59	30						639.47	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	1	0	1	1	1	H1609_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	1	0	1	1	1	H1609_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1609	1	0	1	1	1	H1609_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	1	0	1	1	1	H1609_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1609	1	0	1	1	1	H1609_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	1	0	1	1	1	H1609_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	1	0	1	1	1	H1609_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1115.09	33						1081.64	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	9	0	1	1	1	H1609_009_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	9	0	1	1	1	H1609_009_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1609	9	0	1	1	1	H1609_009_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	9	0	1	1	1	H1609_009_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1609	9	0	1	1	1	H1609_009_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	9	0	1	1	1	H1609_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	9	0	1	1	1	H1609_009_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											829.45	33						807.19	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	16	0	1	1	1	H1609_016_0	2	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	16	0	1	1	1	H1609_016_0	2	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	16	0	1	1	1	H1609_016_0	2	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	16	0	1	1	1	H1609_016_0	2	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	16	0	1	1	1	H1609_016_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					0	0	0											47	94	141				0	0	0					47			47			1.57	0		1.57	0	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	16	0	1	1	1	H1609_016_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					35	70	105											100	200	300				35	70	105					100			100			3.33	1.17		3.33	1.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	16	0	1	1	1	H1609_016_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											805.88	33						763.74	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	17	0	1	1	1	H1609_017_0	3	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	17	0	1	1	1	H1609_017_0	3	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	17	0	1	1	1	H1609_017_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	17	0	1	1	1	H1609_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	17	0	1	1	1	H1609_017_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				612.72	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	18	0	1	1	1	H1609_018_0	2	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	18	0	1	1	1	H1609_018_0	2	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	18	0	1	1	1	H1609_018_0	2	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	18	0	1	1	1	H1609_018_0	2	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	18	0	1	1	1	H1609_018_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					3	6	9											47	94	141				3	6	9					47			47			1.57	0.1		1.57	0.1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	18	0	1	1	1	H1609_018_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					85	170	255											100	200	300				85	170	255					100			100			3.33	2.83		3.33	2.83	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	18	0	1	1	1	H1609_018_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											773.46	33						740.89	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	19	0	1	1	1	H1609_019_0	3	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	19	0	1	1	1	H1609_019_0	3	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	19	0	1	1	1	H1609_019_0	3	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	19	0	1	1	1	H1609_019_0	3	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	19	0	1	1	1	H1609_019_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	19	0	1	1	1	H1609_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	19	0	1	1	1	H1609_019_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				582.8	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	20	0	1	1	1	H1609_020_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	20	0	1	1	1	H1609_020_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	20	0	1	1	1	H1609_020_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	20	0	1	1	1	H1609_020_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	20	0	1	1	1	H1609_020_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	20	0	1	1	1	H1609_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	20	0	1	1	1	H1609_020_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											819.78	33						783.94	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	21	0	1	1	1	H1609_021_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	21	0	1	1	1	H1609_021_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	21	0	1	1	1	H1609_021_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	21	0	1	1	1	H1609_021_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	21	0	1	1	1	H1609_021_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	21	0	1	1	1	H1609_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	21	0	1	1	1	H1609_021_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1067.55	33						1090.3	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	22	0	1	1	1	H1609_022_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	22	0	1	1	1	H1609_022_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	22	0	1	1	1	H1609_022_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	22	0	1	1	1	H1609_022_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	22	0	1	1	1	H1609_022_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	22	0	1	1	1	H1609_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	22	0	1	1	1	H1609_022_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											761.3	33						779.41	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	23	0	1	1	1	H1609_023_0	3	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	23	0	1	1	1	H1609_023_0	3	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	23	0	1	1	1	H1609_023_0	3	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	23	0	1	1	1	H1609_023_0	3	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	23	0	1	1	1	H1609_023_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	23	0	1	1	1	H1609_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	23	0	1	1	1	H1609_023_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				572.81	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	25	0	1	1	1	H1609_025_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	25	0	1	1	1	H1609_025_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	25	0	1	1	1	H1609_025_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	25	0	1	1	1	H1609_025_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	25	0	1	1	1	H1609_025_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	25	0	1	1	1	H1609_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	25	0	1	1	1	H1609_025_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											899.29	33						909.88	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	26	0	1	1	1	H1609_026_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	26	0	1	1	1	H1609_026_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	26	0	1	1	1	H1609_026_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	26	0	1	1	1	H1609_026_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	26	0	1	1	1	H1609_026_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	26	0	1	1	1	H1609_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	26	0	1	1	1	H1609_026_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											938.77	33						1017.5	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	27	0	1	1	1	H1609_027_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	27	0	1	1	1	H1609_027_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	27	0	1	1	1	H1609_027_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	27	0	1	1	1	H1609_027_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	27	0	1	1	1	H1609_027_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	27	0	1	1	1	H1609_027_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	27	0	1	1	1	H1609_027_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											738.1	33						770.22	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	28	0	1	2	1	H1609_028_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	28	0	1	2	1	H1609_028_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1609	28	0	1	2	1	H1609_028_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	28	0	1	2	1	H1609_028_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1609	28	0	1	2	1	H1609_028_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	28	0	1	2	1	H1609_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	28	0	1	2	1	H1609_028_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.44	29						601.68	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	34	0	1	1	1	H1609_034_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	34	0	1	1	1	H1609_034_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	34	0	1	1	1	H1609_034_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	34	0	1	1	1	H1609_034_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	34	0	1	1	1	H1609_034_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	34	0	1	1	1	H1609_034_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	34	0	1	1	1	H1609_034_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											805.91	33						844.81	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	35	0	1	1	1	H1609_035_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	35	0	1	1	1	H1609_035_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	35	0	1	1	1	H1609_035_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	35	0	1	1	1	H1609_035_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	35	0	1	1	1	H1609_035_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	35	0	1	1	1	H1609_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	35	0	1	1	1	H1609_035_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											805.61	33						844.49	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	37	0	1	1	1	H1609_037_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	37	0	1	1	1	H1609_037_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	37	0	1	1	1	H1609_037_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	37	0	1	1	1	H1609_037_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	37	0	1	1	1	H1609_037_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	37	0	1	1	1	H1609_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	37	0	1	1	1	H1609_037_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											805.81	33						844.71	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	38	0	1	1	1	H1609_038_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	38	0	1	1	1	H1609_038_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	38	0	1	1	1	H1609_038_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	38	0	1	1	1	H1609_038_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	38	0	1	1	1	H1609_038_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	38	0	1	1	1	H1609_038_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	38	0	1	1	1	H1609_038_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											806.14	33						845.06	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	39	0	1	1	1	H1609_039_0	3	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	39	0	1	1	1	H1609_039_0	3	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	39	0	1	1	1	H1609_039_0	3	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	39	0	1	1	1	H1609_039_0	3	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	39	0	1	1	1	H1609_039_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	39	0	1	1	1	H1609_039_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	39	0	1	1	1	H1609_039_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				566.88	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	40	0	1	1	1	H1609_040_0	3	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	40	0	1	1	1	H1609_040_0	3	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	40	0	1	1	1	H1609_040_0	3	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	40	0	1	1	1	H1609_040_0	3	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	40	0	1	1	1	H1609_040_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	40	0	1	1	1	H1609_040_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	40	0	1	1	1	H1609_040_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				566.88	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	41	0	1	1	1	H1609_041_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	41	0	1	1	1	H1609_041_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	41	0	1	1	1	H1609_041_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	41	0	1	1	1	H1609_041_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	41	0	1	1	1	H1609_041_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	41	0	1	1	1	H1609_041_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	41	0	1	1	1	H1609_041_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											805.94	33						844.85	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	42	0	1	1	1	H1609_042_0	3	Preferred Generic	4	1	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	42	0	1	1	1	H1609_042_0	3	Preferred Generic	4	1	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	42	0	1	1	1	H1609_042_0	3	Generic	4	1	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	42	0	1	1	1	H1609_042_0	3	Generic	4	1	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	42	0	1	1	1	H1609_042_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					35	70	105											47	94	141				35	70	105					47			47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	42	0	1	1	1	H1609_042_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					90	180	270											100	200	300				90	180	270					100			100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	42	0	1	1	1	H1609_042_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											826.75	33						784.89	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	43	0	1	1	1	H1609_043_0	6	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	43	0	1	1	1	H1609_043_0	6	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	43	0	1	1	1	H1609_043_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	43	0	1	1	1	H1609_043_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	43	0	1	1	1	H1609_043_0	6	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				577.6	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	44	0	1	1	1	H1609_044_0	4	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	44	0	1	1	1	H1609_044_0	4	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	44	0	1	1	1	H1609_044_0	4	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	44	0	1	1	1	H1609_044_0	4	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	44	0	1	1	1	H1609_044_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	44	0	1	1	1	H1609_044_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	44	0	1	1	1	H1609_044_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				566.88	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	45	0	1	1	1	H1609_045_0	4	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	45	0	1	1	1	H1609_045_0	4	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	45	0	1	1	1	H1609_045_0	4	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	45	0	1	1	1	H1609_045_0	4	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	45	0	1	1	1	H1609_045_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	45	0	1	1	1	H1609_045_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	45	0	1	1	1	H1609_045_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				566.88	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	46	0	1	1	1	H1609_046_0	5	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	46	0	1	1	1	H1609_046_0	5	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	46	0	1	1	1	H1609_046_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	46	0	1	1	1	H1609_046_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	46	0	1	1	1	H1609_046_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				577.6	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	47	0	1	1	1	H1609_047_0	4	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	47	0	1	1	1	H1609_047_0	4	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	47	0	1	1	1	H1609_047_0	4	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	47	0	1	1	1	H1609_047_0	4	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	47	0	1	1	1	H1609_047_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	47	0	1	1	1	H1609_047_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	47	0	1	1	1	H1609_047_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				566.88	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	48	0	1	1	1	H1609_048_0	5	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	48	0	1	1	1	H1609_048_0	5	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	48	0	1	1	1	H1609_048_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	48	0	1	1	1	H1609_048_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	48	0	1	1	1	H1609_048_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				577.6	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	49	0	1	1	1	H1609_049_0	4	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	49	0	1	1	1	H1609_049_0	4	Preferred Generic	4	1	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	49	0	1	1	1	H1609_049_0	4	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	49	0	1	1	1	H1609_049_0	4	Generic	4	1	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H1609	49	0	1	1	1	H1609_049_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	49	0	1	1	1	H1609_049_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	49	0	1	1	1	H1609_049_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				566.88	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	50	0	1	1	1	H1609_050_0	3	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	50	0	1	1	1	H1609_050_0	3	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	50	0	1	1	1	H1609_050_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	50	0	1	1	1	H1609_050_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	50	0	1	1	1	H1609_050_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				577.6	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	51	0	1	1	1	H1609_051_0	3	Preferred Generic	4	1	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	51	0	1	1	1	H1609_051_0	3	Generic	4	1	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												3
H1609	51	0	1	1	1	H1609_051_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	51	0	1	1	1	H1609_051_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1609	51	0	1	1	1	H1609_051_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				577.6	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1610	1	0	1	1	1	H1610_001_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1610	1	0	1	1	1	H1610_001_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1610	1	0	1	1	1	H1610_001_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1610	1	0	1	1	1	H1610_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1610	1	0	1	1	1	H1610_001_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				608.09	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1659	1	0	1	4	1	H1659_001_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					5		0													30						0				10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	1	0	1	4	1	H1659_001_0	6	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								13		39					8		0													39						0				13				13			0.43	0.27				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	1	0	1	4	1	H1659_001_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								40		120					30		75													120						75				40				40			1.33	1				1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	1	0	1	4	1	H1659_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								90		270					80		200													270						200				90				90			3	2.67				2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	1	0	1	4	1	H1659_001_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	2	0	1	4	1	H1659_002_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								12		36					7		0													36						0				12				12			0.4	0.23				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	2	0	1	4	1	H1659_002_0	5	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								17		51					12		0													51						0				17				17			0.57	0.4				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	2	0	1	4	1	H1659_002_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								45		135					35		87.5													135						87.5				45				45			1.5	1.17				1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	2	0	1	4	1	H1659_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								95		285					85		212.5													285						212.5				95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	2	0	1	4	1	H1659_002_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	3	0	1	4	1	H1659_003_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								15		45					10		0													45						0				15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	3	0	1	4	1	H1659_003_0	5	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					15		0													60						0				20				20			0.67	0.5				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	3	0	1	4	1	H1659_003_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					40		100													141						100				47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	3	0	1	4	1	H1659_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					90		225													300						225				100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1659	3	0	1	4	1	H1659_003_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1660	13	0	1	1	1	H1660_013_0	6	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	13	0	1	1	1	H1660_013_0	6	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	13	0	1	1	1	H1660_013_0	6	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	13	0	1	1	1	H1660_013_0	6	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	13	0	1	1	1	H1660_013_0	6	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	13	0	1	1	1	H1660_013_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1615	27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	14	0	1	1	1	H1660_014_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	14	0	1	1	1	H1660_014_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	14	0	1	1	1	H1660_014_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	14	0	1	1	1	H1660_014_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	14	0	1	1	1	H1660_014_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	14	0	1	1	1	H1660_014_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1495	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	15	0	1	1	1	H1660_015_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	15	0	1	1	1	H1660_015_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	15	0	1	1	1	H1660_015_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	15	0	1	1	1	H1660_015_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	15	0	1	1	1	H1660_015_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	15	0	1	1	1	H1660_015_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1495	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	1	1	1	1	H1660_016_1	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	1	1	1	1	H1660_016_1	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	16	1	1	1	1	H1660_016_1	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	1	1	1	1	H1660_016_1	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	1	1	1	1	H1660_016_1	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	1	1	1	1	H1660_016_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1555	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	2	1	1	1	H1660_016_2	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	2	1	1	1	H1660_016_2	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	16	2	1	1	1	H1660_016_2	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	2	1	1	1	H1660_016_2	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	2	1	1	1	H1660_016_2	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	16	2	1	1	1	H1660_016_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1555	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	1	1	1	1	H1660_017_1	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	1	1	1	1	H1660_017_1	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	17	1	1	1	1	H1660_017_1	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	1	1	1	1	H1660_017_1	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	1	1	1	1	H1660_017_1	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	1	1	1	1	H1660_017_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1975	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	2	1	1	1	H1660_017_2	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	2	1	1	1	H1660_017_2	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	17	2	1	1	1	H1660_017_2	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	2	1	1	1	H1660_017_2	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	2	1	1	1	H1660_017_2	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	17	2	1	1	1	H1660_017_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1975	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	18	0	1	2	1	H1660_018_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	18	0	1	2	1	H1660_018_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H1660	18	0	1	2	1	H1660_018_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	18	0	1	2	1	H1660_018_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	18	0	1	2	1	H1660_018_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1660	18	0	1	2	1	H1660_018_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1615	27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1664	1	0	1	1	1	H1664_001_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	1	0	1	1	1	H1664_001_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1664	1	0	1	1	1	H1664_001_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					5	10	15					0	0	0																20				20			0.67	0.17	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	1	0	1	1	1	H1664_001_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	1	0	1	1	1	H1664_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	1	0	1	1	1	H1664_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	1	0	1	1	1	H1664_001_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	1	0	1	1	1	H1664_001_0	3	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1664	2	0	1	1	1	H1664_002_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	2	0	1	1	1	H1664_002_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1664	2	0	1	1	1	H1664_002_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					5	10	15					0	0	0																20				20			0.67	0.17	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	2	0	1	1	1	H1664_002_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	2	0	1	1	1	H1664_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	2	0	1	1	1	H1664_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	2	0	1	1	1	H1664_002_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	2	0	1	1	1	H1664_002_0	3	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1664	4	0	1	1	1	H1664_004_0	2	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	4	0	1	1	1	H1664_004_0	2	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1664	4	0	1	1	1	H1664_004_0	2	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					5	10	15					0	0	0																20				20			0.67	0.17	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	4	0	1	1	1	H1664_004_0	2	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	4	0	1	1	1	H1664_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	4	0	1	1	1	H1664_004_0	2	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	4	0	1	1	1	H1664_004_0	2	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	4	0	1	1	1	H1664_004_0	2	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1664	5	0	1	1	1	H1664_005_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	5	0	1	1	1	H1664_005_0	4	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1664	5	0	1	1	1	H1664_005_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			0	0	0																15				15		0.5			0			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	5	0	1	1	1	H1664_005_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	5	0	1	1	1	H1664_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	5	0	1	1	1	H1664_005_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	5	0	1	1	1	H1664_005_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1664	5	0	1	1	1	H1664_005_0	4	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1666	1	0	1	4	1	H1666_001_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	1	0	1	4	1	H1666_001_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1666	1	0	1	4	1	H1666_001_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	1	0	1	4	1	H1666_001_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	1	0	1	4	1	H1666_001_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	1	0	1	4	1	H1666_001_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	2	0	1	4	1	H1666_002_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	2	0	1	4	1	H1666_002_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1666	2	0	1	4	1	H1666_002_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	2	0	1	4	1	H1666_002_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	2	0	1	4	1	H1666_002_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	2	0	1	4	1	H1666_002_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	3	0	1	4	1	H1666_003_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	3	0	1	4	1	H1666_003_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1666	3	0	1	4	1	H1666_003_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	3	0	1	4	1	H1666_003_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	3	0	1	4	1	H1666_003_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	3	0	1	4	1	H1666_003_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	4	0	1	4	1	H1666_004_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	4	0	1	4	1	H1666_004_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1666	4	0	1	4	1	H1666_004_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	4	0	1	4	1	H1666_004_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	4	0	1	4	1	H1666_004_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	4	0	1	4	1	H1666_004_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	5	0	1	4	1	H1666_005_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	5	0	1	4	1	H1666_005_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1666	5	0	1	4	1	H1666_005_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	5	0	1	4	1	H1666_005_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	5	0	1	4	1	H1666_005_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	5	0	1	4	1	H1666_005_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	6	0	1	4	1	H1666_006_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	6	0	1	4	1	H1666_006_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1666	6	0	1	4	1	H1666_006_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	6	0	1	4	1	H1666_006_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	6	0	1	4	1	H1666_006_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	6	0	1	4	1	H1666_006_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	8	0	1	4	1	H1666_008_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	8	0	1	4	1	H1666_008_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1666	8	0	1	4	1	H1666_008_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	8	0	1	4	1	H1666_008_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	8	0	1	4	1	H1666_008_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1666	8	0	1	4	1	H1666_008_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1692	2	0	1	1	1	H1692_002_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	2	0	1	1	1	H1692_002_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1692	2	0	1	1	1	H1692_002_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	2	0	1	1	1	H1692_002_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1692	2	0	1	1	1	H1692_002_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	2	0	1	1	1	H1692_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	2	0	1	1	1	H1692_002_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											815.43	33						782.99	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	3	0	1	1	1	H1692_003_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	3	0	1	1	1	H1692_003_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1692	3	0	1	1	1	H1692_003_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	3	0	1	1	1	H1692_003_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1692	3	0	1	1	1	H1692_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	3	0	1	1	1	H1692_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	3	0	1	1	1	H1692_003_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											887.45	33						835.35	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	4	0	1	1	1	H1692_004_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	4	0	1	1	1	H1692_004_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1692	4	0	1	1	1	H1692_004_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	4	0	1	1	1	H1692_004_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1692	4	0	1	1	1	H1692_004_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	4	0	1	1	1	H1692_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	4	0	1	1	1	H1692_004_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											854.21	33						810.22	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	5	0	1	1	1	H1692_005_0	6	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	5	0	1	1	1	H1692_005_0	6	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	5	0	1	1	1	H1692_005_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	5	0	1	1	1	H1692_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1692	5	0	1	1	1	H1692_005_0	6	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				609.81	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H1723	1	0	1	48	5	H1723_001_0	3	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H1723	1	0	1	48	5	H1723_001_0	3	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H1723	1	0	1	48	5	H1723_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H1737	1	0	1	1	1	H1737_001_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1737	1	0	1	1	1	H1737_001_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1737	1	0	1	1	1	H1737_001_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1737	1	0	1	1	1	H1737_001_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											39.44	50	50	50				54.17	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1737	1	0	1	1	1	H1737_001_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H1787	2	0	1	1	1	H1787_002_0	7	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4	8	12																																						4			4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1787	2	0	1	1	1	H1787_002_0	7	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1787	2	0	1	1	1	H1787_002_0	7	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1787	2	0	1	1	1	H1787_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1787	2	0	1	1	1	H1787_002_0	7	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1846	4	0	1	4	1	H1846_004_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1846	4	0	1	4	1	H1846_004_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1846	4	0	1	4	1	H1846_004_0	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1846	4	0	1	4	1	H1846_004_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1846	4	0	1	4	1	H1846_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1846	4	0	1	4	1	H1846_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1894	1	0	1	1	1	H1894_001_0	10	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	1	0	1	1	1	H1894_001_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	1	0	1	1	1	H1894_001_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	1	0	1	1	1	H1894_001_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	1	0	1	1	1	H1894_001_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	1	0	1	1	1	H1894_001_0	10	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	1	0	1	1	1	H1894_001_0	10	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1894	2	0	1	1	1	H1894_002_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	2	0	1	1	1	H1894_002_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1894	2	0	1	1	1	H1894_002_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								8	16	24					8	16	24					8	24	24																8				8			0.27	0.27	0.27			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	2	0	1	1	1	H1894_002_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	2	0	1	1	1	H1894_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	2	0	1	1	1	H1894_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	2	0	1	1	1	H1894_002_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1894	2	0	1	1	1	H1894_002_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1914	1	0	1	4	1	H1914_001_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1914	1	0	1	4	1	H1914_001_0	8	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1914	1	0	1	4	1	H1914_001_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1914	1	0	1	4	1	H1914_001_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1914	1	0	1	4	1	H1914_001_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.23	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1914	1	0	1	4	1	H1914_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	1	0	1	1	1	H1944_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	1	0	1	1	1	H1944_001_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	1	0	1	1	1	H1944_001_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	1	0	1	1	1	H1944_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	1	0	1	1	1	H1944_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	1	0	1	1	1	H1944_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				670	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	4	0	1	1	1	H1944_004_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	4	0	1	1	1	H1944_004_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	4	0	1	1	1	H1944_004_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	4	0	1	1	1	H1944_004_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	4	0	1	1	1	H1944_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	4	0	1	1	1	H1944_004_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				934	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	5	0	1	1	1	H1944_005_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	5	0	1	1	1	H1944_005_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	5	0	1	1	1	H1944_005_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	5	0	1	1	1	H1944_005_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	5	0	1	1	1	H1944_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	5	0	1	1	1	H1944_005_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				691	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	6	0	1	1	1	H1944_006_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	6	0	1	1	1	H1944_006_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	6	0	1	1	1	H1944_006_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	6	0	1	1	1	H1944_006_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	6	0	1	1	1	H1944_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	6	0	1	1	1	H1944_006_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				901	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	9	0	1	1	1	H1944_009_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	9	0	1	1	1	H1944_009_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1944	9	0	1	1	1	H1944_009_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	9	0	1	1	1	H1944_009_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1944	9	0	1	1	1	H1944_009_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	9	0	1	1	1	H1944_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	9	0	1	1	1	H1944_009_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				770	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	10	0	1	1	1	H1944_010_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	10	0	1	1	1	H1944_010_0	5	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	10	0	1	1	1	H1944_010_0	5	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	10	0	1	1	1	H1944_010_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	10	0	1	1	1	H1944_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	10	0	1	1	1	H1944_010_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				883	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	11	0	1	1	1	H1944_011_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	11	0	1	1	1	H1944_011_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	11	0	1	1	1	H1944_011_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	11	0	1	1	1	H1944_011_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	11	0	1	1	1	H1944_011_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	11	0	1	1	1	H1944_011_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				890	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	14	0	1	2	1	H1944_014_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	14	0	1	2	1	H1944_014_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	9		18																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	14	0	1	2	1	H1944_014_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	9		18																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	14	0	1	2	1	H1944_014_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	14	0	1	2	1	H1944_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	14	0	1	2	1	H1944_014_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1022	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	16	0	1	2	1	H1944_016_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	16	0	1	2	1	H1944_016_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	9		18																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	16	0	1	2	1	H1944_016_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	9		18																											27						0				9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	16	0	1	2	1	H1944_016_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	16	0	1	2	1	H1944_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	16	0	1	2	1	H1944_016_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				990	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	17	0	1	1	1	H1944_017_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	17	0	1	1	1	H1944_017_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	17	0	1	1	1	H1944_017_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	17	0	1	1	1	H1944_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	17	0	1	1	1	H1944_017_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				659	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	18	0	1	1	1	H1944_018_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	18	0	1	1	1	H1944_018_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	18	0	1	1	1	H1944_018_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	18	0	1	1	1	H1944_018_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	18	0	1	1	1	H1944_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	18	0	1	1	1	H1944_018_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1109	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	19	0	1	1	1	H1944_019_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	19	0	1	1	1	H1944_019_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	19	0	1	1	1	H1944_019_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	19	0	1	1	1	H1944_019_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	19	0	1	1	1	H1944_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	19	0	1	1	1	H1944_019_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				650	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	20	0	1	2	1	H1944_020_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	20	0	1	2	1	H1944_020_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	20	0	1	2	1	H1944_020_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	20	0	1	2	1	H1944_020_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	20	0	1	2	1	H1944_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	20	0	1	2	1	H1944_020_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1379	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	21	0	1	1	1	H1944_021_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	21	0	1	1	1	H1944_021_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	21	0	1	1	1	H1944_021_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	21	0	1	1	1	H1944_021_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	21	0	1	1	1	H1944_021_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	21	0	1	1	1	H1944_021_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1124	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	22	0	1	1	1	H1944_022_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	22	0	1	1	1	H1944_022_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	22	0	1	1	1	H1944_022_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	22	0	1	1	1	H1944_022_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	22	0	1	1	1	H1944_022_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	22	0	1	1	1	H1944_022_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				572	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	24	0	1	1	1	H1944_024_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	24	0	1	1	1	H1944_024_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	24	0	1	1	1	H1944_024_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	24	0	1	1	1	H1944_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	24	0	1	1	1	H1944_024_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				711	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	25	0	1	1	1	H1944_025_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	25	0	1	1	1	H1944_025_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	25	0	1	1	1	H1944_025_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	25	0	1	1	1	H1944_025_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	25	0	1	1	1	H1944_025_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	25	0	1	1	1	H1944_025_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1261	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	28	0	1	1	1	H1944_028_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	28	0	1	1	1	H1944_028_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	28	0	1	1	1	H1944_028_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	28	0	1	1	1	H1944_028_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	28	0	1	1	1	H1944_028_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	28	0	1	1	1	H1944_028_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				916	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	31	0	1	1	1	H1944_031_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	31	0	1	1	1	H1944_031_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	31	0	1	1	1	H1944_031_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	31	0	1	1	1	H1944_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	31	0	1	1	1	H1944_031_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				812	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	32	0	1	1	1	H1944_032_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	32	0	1	1	1	H1944_032_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	32	0	1	1	1	H1944_032_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H1944	32	0	1	1	1	H1944_032_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	32	0	1	1	1	H1944_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1944	32	0	1	1	1	H1944_032_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				928	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1947	1	0	1	1	1	H1947_001_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1947	1	0	1	1	1	H1947_001_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1947	1	0	1	1	1	H1947_001_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	8	8																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1947	1	0	1	1	1	H1947_001_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								44	88	132					44	88	132					44	88	88																44				44			1.47	1.47	1.47			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1947	1	0	1	1	1	H1947_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1947	1	0	1	1	1	H1947_001_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1947	1	0	1	1	1	H1947_001_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1947	1	0	1	1	1	H1947_001_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1951	13	0	1	1	1	H1951_013_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	13	0	1	1	1	H1951_013_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	13	0	1	1	1	H1951_013_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	13	0	1	1	1	H1951_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	13	0	1	1	1	H1951_013_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	24	0	1	1	1	H1951_024_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	24	0	1	1	1	H1951_024_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	24	0	1	1	1	H1951_024_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	24	0	1	1	1	H1951_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	24	0	1	1	1	H1951_024_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	28	0	1	1	1	H1951_028_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	28	0	1	1	1	H1951_028_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	28	0	1	1	1	H1951_028_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	28	0	1	1	1	H1951_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	28	0	1	1	1	H1951_028_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	32	0	1	1	1	H1951_032_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	32	0	1	1	1	H1951_032_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	32	0	1	1	1	H1951_032_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	32	0	1	1	1	H1951_032_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	32	0	1	1	1	H1951_032_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	33	0	1	1	1	H1951_033_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	33	0	1	1	1	H1951_033_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	33	0	1	1	1	H1951_033_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	33	0	1	1	1	H1951_033_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	33	0	1	1	1	H1951_033_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	34	0	1	1	1	H1951_034_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	34	0	1	1	1	H1951_034_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	34	0	1	1	1	H1951_034_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	34	0	1	1	1	H1951_034_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	34	0	1	1	1	H1951_034_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	38	0	1	1	1	H1951_038_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	38	0	1	1	1	H1951_038_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	38	0	1	1	1	H1951_038_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	38	0	1	1	1	H1951_038_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	38	0	1	1	1	H1951_038_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	39	0	1	1	1	H1951_039_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	39	0	1	1	1	H1951_039_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	39	0	1	1	1	H1951_039_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	39	0	1	1	1	H1951_039_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	39	0	1	1	1	H1951_039_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	41	0	1	1	1	H1951_041_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	41	0	1	1	1	H1951_041_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	41	0	1	1	1	H1951_041_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	41	0	1	1	1	H1951_041_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	41	0	1	1	1	H1951_041_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	44	0	1	1	1	H1951_044_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1951	44	0	1	1	1	H1951_044_0	3	Preferred Generic	4	11	1	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1951	44	0	1	1	1	H1951_044_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1951	44	0	1	1	1	H1951_044_0	3	Generic	4	11	3	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	3
H1951	44	0	1	1	1	H1951_044_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1951	44	0	1	1	1	H1951_044_0	3	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			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	44	0	1	1	1	H1951_044_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1951	44	0	1	1	1	H1951_044_0	3	Non-Preferred Drug	4	11	1	2	4	3		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1951	44	0	1	1	1	H1951_044_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	44	0	1	1	1	H1951_044_0	3	Specialty Tier	4	11	1	1	5	3		10	1		10	1				30								30			30		31												15							15												15						15					15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H1951	44	0	1	1	1	H1951_044_0	3	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H1951	44	0	1	1	1	H1951_044_0	3	Select Care Drugs	4	11	1	2	6	3		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H1951	47	1	1	1	1	H1951_047_1	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	1	1	1	1	H1951_047_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	1	1	1	1	H1951_047_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	1	1	1	1	H1951_047_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	1	1	1	1	H1951_047_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	2	1	1	1	H1951_047_2	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	2	1	1	1	H1951_047_2	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	2	1	1	1	H1951_047_2	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	2	1	1	1	H1951_047_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	47	2	1	1	1	H1951_047_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	1	1	1	1	H1951_048_1	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	1	1	1	1	H1951_048_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	1	1	1	1	H1951_048_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	1	1	1	1	H1951_048_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	1	1	1	1	H1951_048_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	2	1	1	1	H1951_048_2	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	2	1	1	1	H1951_048_2	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	2	1	1	1	H1951_048_2	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	2	1	1	1	H1951_048_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	48	2	1	1	1	H1951_048_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	1	1	1	1	H1951_049_1	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	1	1	1	1	H1951_049_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	1	1	1	1	H1951_049_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	1	1	1	1	H1951_049_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	1	1	1	1	H1951_049_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	2	1	1	1	H1951_049_2	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	2	1	1	1	H1951_049_2	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	2	1	1	1	H1951_049_2	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	2	1	1	1	H1951_049_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	2	1	1	1	H1951_049_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	3	1	1	1	H1951_049_3	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	3	1	1	1	H1951_049_3	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	3	1	1	1	H1951_049_3	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	3	1	1	1	H1951_049_3	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	49	3	1	1	1	H1951_049_3	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	50	0	1	1	1	H1951_050_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	50	0	1	1	1	H1951_050_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	50	0	1	1	1	H1951_050_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	50	0	1	1	1	H1951_050_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1951	50	0	1	1	1	H1951_050_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	1	1	1	1	H1961_014_1	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	1	1	1	1	H1961_014_1	5	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	14	1	1	1	1	H1961_014_1	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	1	1	1	1	H1961_014_1	5	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	14	1	1	1	1	H1961_014_1	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						135				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	1	1	1	1	H1961_014_1	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						300				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	1	1	1	1	H1961_014_1	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				752	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	2	1	1	1	H1961_014_2	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	2	1	1	1	H1961_014_2	5	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	14	2	1	1	1	H1961_014_2	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	2	1	1	1	H1961_014_2	5	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	14	2	1	1	1	H1961_014_2	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						135				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	2	1	1	1	H1961_014_2	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						300				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	14	2	1	1	1	H1961_014_2	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				752	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	17	0	1	2	1	H1961_017_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	17	0	1	2	1	H1961_017_0	5	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	17	0	1	2	1	H1961_017_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	17	0	1	2	1	H1961_017_0	5	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	17	0	1	2	1	H1961_017_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						135				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	17	0	1	2	1	H1961_017_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						300				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	17	0	1	2	1	H1961_017_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				605	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	18	0	1	1	1	H1961_018_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	18	0	1	1	1	H1961_018_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	18	0	1	1	1	H1961_018_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	18	0	1	1	1	H1961_018_0	6	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H1961	18	0	1	1	1	H1961_018_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						135				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	18	0	1	1	1	H1961_018_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						300				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1961	18	0	1	1	1	H1961_018_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				615	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	2	0	1	1	1	H1969_002_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	2	0	1	1	1	H1969_002_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	2	0	1	1	1	H1969_002_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	2	0	1	1	1	H1969_002_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	2	0	1	1	1	H1969_002_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											749.89	29						749.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	4	0	1	1	1	H1969_004_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	4	0	1	1	1	H1969_004_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	4	0	1	1	1	H1969_004_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	4	0	1	1	1	H1969_004_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	4	0	1	1	1	H1969_004_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											801.61	31						801.61	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	3	1	1	1	H1969_007_3	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	3	1	1	1	H1969_007_3	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	3	1	1	1	H1969_007_3	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	3	1	1	1	H1969_007_3	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	3	1	1	1	H1969_007_3	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											749.89	29						749.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	4	1	1	1	H1969_007_4	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	4	1	1	1	H1969_007_4	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	4	1	1	1	H1969_007_4	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	4	1	1	1	H1969_007_4	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	7	4	1	1	1	H1969_007_4	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											749.89	29						749.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	1	1	1	1	H1969_008_1	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	1	1	1	1	H1969_008_1	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	1	1	1	1	H1969_008_1	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	1	1	1	1	H1969_008_1	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	1	1	1	1	H1969_008_1	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											801.61	31						801.61	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	2	1	1	1	H1969_008_2	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	2	1	1	1	H1969_008_2	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	2	1	1	1	H1969_008_2	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	2	1	1	1	H1969_008_2	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1969	8	2	1	1	1	H1969_008_2	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											801.61	31						801.61	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1977	1	0	1	48	5	H1977_001_0	1	Generic Drugs	4	1			1	1	10		1			1	30														30		31																																																					"Generic Drugs, Brand Drugs"	3	0	0	0	0			0	0			
H1977	1	0	1	48	5	H1977_001_0	1	Brand Drugs	4	10			2	1	10		1			1	30														30		31																																																					"Generic Drugs, Brand Drugs"	3	0	0	0	0			0	0			
H1994	1	0	1	1	1	H1994_001_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	1	0	1	1	1	H1994_001_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	1	0	1	1	1	H1994_001_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	1	0	1	1	1	H1994_001_0	4	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	1	0	1	1	1	H1994_001_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	1	0	1	1	1	H1994_001_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	1	0	1	1	1	H1994_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1069.1	29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	2	0	1	1	1	H1994_002_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	2	0	1	1	1	H1994_002_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	2	0	1	1	1	H1994_002_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	2	0	1	1	1	H1994_002_0	4	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	2	0	1	1	1	H1994_002_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	2	0	1	1	1	H1994_002_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	2	0	1	1	1	H1994_002_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				917.59	29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	3	0	1	1	1	H1994_003_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	3	0	1	1	1	H1994_003_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	3	0	1	1	1	H1994_003_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	3	0	1	1	1	H1994_003_0	4	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	3	0	1	1	1	H1994_003_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	3	0	1	1	1	H1994_003_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	3	0	1	1	1	H1994_003_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1069.69	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	4	0	1	1	1	H1994_004_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	4	0	1	1	1	H1994_004_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	4	0	1	1	1	H1994_004_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	4	0	1	1	1	H1994_004_0	4	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	4	0	1	1	1	H1994_004_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	4	0	1	1	1	H1994_004_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	4	0	1	1	1	H1994_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1076.05	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	7	0	1	1	1	H1994_007_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	7	0	1	1	1	H1994_007_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1994	7	0	1	1	1	H1994_007_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	7	0	1	1	1	H1994_007_0	4	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	7	0	1	1	1	H1994_007_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	7	0	1	1	1	H1994_007_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	7	0	1	1	1	H1994_007_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1132.27	29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	8	0	1	1	1	H1994_008_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	8	0	1	1	1	H1994_008_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	8	0	1	1	1	H1994_008_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	8	0	1	1	1	H1994_008_0	4	Generic	4	11	1	2	2	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2	3	
H1994	8	0	1	1	1	H1994_008_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	8	0	1	1	1	H1994_008_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	8	0	1	1	1	H1994_008_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1191.08	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	9	0	1	1	1	H1994_009_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	9	0	1	1	1	H1994_009_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1994	9	0	1	1	1	H1994_009_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	8	16	24																			0	0	0																8				8		0.27			0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	9	0	1	1	1	H1994_009_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	9	0	1	1	1	H1994_009_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	9	0	1	1	1	H1994_009_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1570.94	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	10	0	1	1	1	H1994_010_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	10	0	1	1	1	H1994_010_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1994	10	0	1	1	1	H1994_010_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			0	0	0																3				3		0.1			0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	10	0	1	1	1	H1994_010_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	10	0	1	1	1	H1994_010_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	10	0	1	1	1	H1994_010_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				927.17	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	11	0	1	1	1	H1994_011_0	4	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	11	0	1	1	1	H1994_011_0	4	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H1994	11	0	1	1	1	H1994_011_0	4	Generic	4	11	1	2	2	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			0	0	0																3				3		0.1			0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	11	0	1	1	1	H1994_011_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	11	0	1	1	1	H1994_011_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1994	11	0	1	1	1	H1994_011_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				927.17	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H1997	2	0	1	1	1	H1997_002_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	2	0	1	1	1	H1997_002_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	2	0	1	1	1	H1997_002_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	2	0	1	1	1	H1997_002_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	2	0	1	1	1	H1997_002_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											749.89	29						749.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	9	0	1	1	1	H1997_009_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	9	0	1	1	1	H1997_009_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	9	0	1	1	1	H1997_009_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	9	0	1	1	1	H1997_009_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	9	0	1	1	1	H1997_009_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	10	0	1	1	1	H1997_010_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	10	0	1	1	1	H1997_010_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	10	0	1	1	1	H1997_010_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	10	0	1	1	1	H1997_010_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	10	0	1	1	1	H1997_010_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	11	0	1	1	1	H1997_011_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	11	0	1	1	1	H1997_011_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	11	0	1	1	1	H1997_011_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	11	0	1	1	1	H1997_011_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H1997	11	0	1	1	1	H1997_011_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											801.61	31						801.61	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	1	0	1	4	1	H2001_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	1	0	1	4	1	H2001_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	1	0	1	4	1	H2001_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	1	0	1	4	1	H2001_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	1	0	1	4	1	H2001_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				759	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	10	0	1	4	1	H2001_010_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	10	0	1	4	1	H2001_010_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	10	0	1	4	1	H2001_010_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H2001	10	0	1	4	1	H2001_010_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	10	0	1	4	1	H2001_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	10	0	1	4	1	H2001_010_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1022	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	17	0	1	4	1	H2001_017_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	17	0	1	4	1	H2001_017_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	17	0	1	4	1	H2001_017_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	17	0	1	4	1	H2001_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2001	17	0	1	4	1	H2001_017_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				1483	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2011	1	0	1	1	1	H2011_001_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	1	0	1	1	1	H2011_001_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	1	0	1	1	1	H2011_001_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	1	0	1	1	1	H2011_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	1	0	1	1	1	H2011_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											770.92	33						770.92	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	1	0	1	1	1	H2011_001_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	1	0	1	1	1	H2011_001_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2011	2	0	1	1	1	H2011_002_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	2	0	1	1	1	H2011_002_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	2	0	1	1	1	H2011_002_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	2	0	1	1	1	H2011_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	2	0	1	1	1	H2011_002_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											752.53	33						752.53	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	2	0	1	1	1	H2011_002_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	2	0	1	1	1	H2011_002_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2011	3	0	1	1	1	H2011_003_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	3	0	1	1	1	H2011_003_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	3	0	1	1	1	H2011_003_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	3	0	1	1	1	H2011_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	3	0	1	1	1	H2011_003_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											780.02	33						780.02	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	3	0	1	1	1	H2011_003_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	3	0	1	1	1	H2011_003_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2011	4	0	1	1	1	H2011_004_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	4	0	1	1	1	H2011_004_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	4	0	1	1	1	H2011_004_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	4	0	1	1	1	H2011_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	4	0	1	1	1	H2011_004_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											762.16	33						762.16	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	4	0	1	1	1	H2011_004_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2011	4	0	1	1	1	H2011_004_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2020	1	0	1	4	1	H2020_001_0	5	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	2		0																			2		0																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	1	0	1	4	1	H2020_001_0	5	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				2	2	30		90				30		31	2		0																			2		0																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2020	1	0	1	4	1	H2020_001_0	5	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	7		21																			7		16																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	1	0	1	4	1	H2020_001_0	5	Generic	4	1	3	2	2	3	110		1	110		1	30		90				2	2	30		90				30		31	7		21																			7		16																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2020	1	0	1	4	1	H2020_001_0	5	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		136																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	1	0	1	4	1	H2020_001_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	1	0	1	4	1	H2020_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				50	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	2	0	1	4	1	H2020_002_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	2		6																			2		0																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	2	0	1	4	1	H2020_002_0	6	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				2	2	30		90				30		31	2		6																			2		0																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2020	2	0	1	4	1	H2020_002_0	6	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	2	0	1	4	1	H2020_002_0	6	Generic	4	1	3	2	2	3	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2020	2	0	1	4	1	H2020_002_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	42		126																			42		121																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	2	0	1	4	1	H2020_002_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	2	0	1	4	1	H2020_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				50	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	3	0	1	4	1	H2020_003_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	3	0	1	4	1	H2020_003_0	6	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2020	3	0	1	4	1	H2020_003_0	6	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	3	0	1	4	1	H2020_003_0	6	Generic	4	1	3	2	2	3	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		15																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2020	3	0	1	4	1	H2020_003_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	42		126																			42		121																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	3	0	1	4	1	H2020_003_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	3	0	1	4	1	H2020_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				50	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	4	0	1	4	1	H2020_004_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	2		0																			2		0																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	4	0	1	4	1	H2020_004_0	6	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				2	2	30		90				30		31	2		0																			2		0																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2020	4	0	1	4	1	H2020_004_0	6	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	7		21																			7		16																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	4	0	1	4	1	H2020_004_0	6	Generic	4	1	3	2	2	3	110		1	110		1	30		90				2	2	30		90				30		31	7		21																			7		16																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2020	4	0	1	4	1	H2020_004_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		136																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	4	0	1	4	1	H2020_004_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	4	0	1	4	1	H2020_004_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				50	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	5	0	1	4	1	H2020_005_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	5	0	1	4	1	H2020_005_0	6	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2020	5	0	1	4	1	H2020_005_0	6	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	5	0	1	4	1	H2020_005_0	6	Generic	4	1	3	2	2	3	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		10																5				5		0.17			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2020	5	0	1	4	1	H2020_005_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	42		126																			42		121																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	5	0	1	4	1	H2020_005_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2020	5	0	1	4	1	H2020_005_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				33	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2029	1	0	1	4	1	H2029_001_0	3	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				2	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2029	1	0	1	4	1	H2029_001_0	3	Generic	4	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2029	1	0	1	4	1	H2029_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				2	2				30		90	30		31	40		120																									40		120				40		110				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2029	1	0	1	4	1	H2029_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				2	2				30		90	30		31	75		225																									75		225				75		215				75				75		2.5				2.5	2.5	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2029	1	0	1	4	1	H2029_001_0	3	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2029	1	0	1	4	1	H2029_001_0	3	Select Care Drugs	4	11	1	2	6	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2032	1	0	1	4	1	H2032_001_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	4	8	8																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	1	0	1	4	1	H2032_001_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	14	28	28																			14	28	28																14				14		0.47			0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	1	0	1	4	1	H2032_001_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	94																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	1	0	1	4	1	H2032_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	99	198	198																			99	198	198																99				99		3.3			3.3			3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	1	0	1	4	1	H2032_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	2	0	1	4	1	H2032_002_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	6																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	2	0	1	4	1	H2032_002_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	14	28	28																			14	28	28																14				14		0.47			0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	2	0	1	4	1	H2032_002_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	94																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	2	0	1	4	1	H2032_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	99	198	198																			99	198	198																99				99		3.3			3.3			3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	2	0	1	4	1	H2032_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	3	0	1	4	1	H2032_003_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	2	4	4																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	3	0	1	4	1	H2032_003_0	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	4	8	8																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2032	3	0	1	4	1	H2032_003_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	12	24	24																			12	24	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	3	0	1	4	1	H2032_003_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	90																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	3	0	1	4	1	H2032_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	190																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2032	3	0	1	4	1	H2032_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					32																				32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2056	1	0	1	1	1	H2056_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	1	0	1	1	1	H2056_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	1	0	1	1	1	H2056_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	1	0	1	1	1	H2056_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	1	0	1	1	1	H2056_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	1	0	1	1	1	H2056_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	1	0	1	1	1	H2056_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											728.58	33						689.48	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	2	0	1	1	1	H2056_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	2	0	1	1	1	H2056_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	2	0	1	1	1	H2056_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	2	0	1	1	1	H2056_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	2	0	1	1	1	H2056_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	2	0	1	1	1	H2056_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	2	0	1	1	1	H2056_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											728.57	33						689.46	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	3	0	1	1	1	H2056_003_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	3	0	1	1	1	H2056_003_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	3	0	1	1	1	H2056_003_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	3	0	1	1	1	H2056_003_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	3	0	1	1	1	H2056_003_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	3	0	1	1	1	H2056_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	3	0	1	1	1	H2056_003_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.45	33						715.81	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	4	0	1	1	1	H2056_004_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	4	0	1	1	1	H2056_004_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	4	0	1	1	1	H2056_004_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	4	0	1	1	1	H2056_004_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2056	4	0	1	1	1	H2056_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	4	0	1	1	1	H2056_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2056	4	0	1	1	1	H2056_004_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.44	33						715.83	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2108	22	0	1	1	1	H2108_022_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								9	18	18					4	8	8											9	18	18				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	22	0	1	1	1	H2108_022_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					15	30	30											20	40	40				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	22	0	1	1	1	H2108_022_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	22	0	1	1	1	H2108_022_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	22	0	1	1	1	H2108_022_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											718.75	27						717.31	27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	28	0	1	1	1	H2108_028_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								9	18	18					4	8	8											9	18	18				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	28	0	1	1	1	H2108_028_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					15	30	30											20	40	40				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	28	0	1	1	1	H2108_028_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	28	0	1	1	1	H2108_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	28	0	1	1	1	H2108_028_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											884.68	33						780.69	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2108	29	0	1	1	1	H2108_029_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								9	18	18					4	8	8											9	18	18				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	29	0	1	1	1	H2108_029_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					15	30	30											20	40	40				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	29	0	1	1	1	H2108_029_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	29	0	1	1	1	H2108_029_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	29	0	1	1	1	H2108_029_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											602.26	27						650.75	27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	29	0	1	1	1	H2108_029_0	5	Select Diabetic Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					5	10	10											6	12	12				5	10	10				6				6			0.2	0.17		0.2	0.17	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	30	0	1	1	1	H2108_030_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								9	18	18					4	8	8											9	18	18				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	30	0	1	1	1	H2108_030_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					15	30	30											20	40	40				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	30	0	1	1	1	H2108_030_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	30	0	1	1	1	H2108_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	30	0	1	1	1	H2108_030_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											940.02	33						880.42	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2108	30	0	1	1	1	H2108_030_0	5	Select Diabetic Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	22					10	20	20											11	22	22				10	20	20				11				11			0.37	0.33		0.37	0.33	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H2120	1	0	1	1	1	H2120_001_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	1	0	1	1	1	H2120_001_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2120	1	0	1	1	1	H2120_001_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	15	15					10	10	10											15	15	15				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	1	0	1	1	1	H2120_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	89	110					42	84	105											47	89	110				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	1	0	1	1	1	H2120_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	189	230					92	184	225											97	189	230				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	1	0	1	1	1	H2120_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	1	0	1	1	1	H2120_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	1	0	1	1	1	H2120_001_0	5	Select Care Drugs	4	11	1	2	6	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2120	2	0	1	1	1	H2120_002_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	2	0	1	1	1	H2120_002_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2120	2	0	1	1	1	H2120_002_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	15	15					10	10	10											15	15	15				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	2	0	1	1	1	H2120_002_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	89	110					42	84	105											47	89	110				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	2	0	1	1	1	H2120_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	189	230					92	184	225											97	189	230				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	2	0	1	1	1	H2120_002_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	2	0	1	1	1	H2120_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	2	0	1	1	1	H2120_002_0	5	Select Care Drugs	4	11	1	2	6	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2120	3	0	1	1	1	H2120_003_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	3	0	1	1	1	H2120_003_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2120	3	0	1	1	1	H2120_003_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	15	15					10	10	10											15	15	15				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	3	0	1	1	1	H2120_003_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	89	110					42	84	105											47	89	110				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	3	0	1	1	1	H2120_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	189	230					92	184	225											97	189	230				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	3	0	1	1	1	H2120_003_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	3	0	1	1	1	H2120_003_0	5	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	3	0	1	1	1	H2120_003_0	5	Select Care Drugs	4	11	1	2	6	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2120	4	0	1	1	1	H2120_004_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	4	0	1	1	1	H2120_004_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	6	6					1	1	1											6	6	6				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2120	4	0	1	1	1	H2120_004_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	15	15					10	10	10											15	15	15				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	4	0	1	1	1	H2120_004_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	89	110					42	84	105											47	89	110				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	4	0	1	1	1	H2120_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	189	230					92	184	225											97	189	230				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	4	0	1	1	1	H2120_004_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	4	0	1	1	1	H2120_004_0	5	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2120	4	0	1	1	1	H2120_004_0	5	Select Care Drugs	4	11	1	2	6	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								5	5	5					0	0	0											5	5	5				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2150	2	0	1	18	6	H2150_002_0	16	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					2	4	6											10	20	30				2	0	0				10				10			0.33	0.06		0.33	0.06	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	2	0	1	18	6	H2150_002_0	16	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					2	4	6											10	20	30				2	0	0				10				10			0.33	0.06		0.33	0.06	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2150	2	0	1	18	6	H2150_002_0	16	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	2	0	1	18	6	H2150_002_0	16	Generic	4	11	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2150	2	0	1	18	6	H2150_002_0	16	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	84				47				47			1.56	1.4		1.56	1.4	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	2	0	1	18	6	H2150_002_0	16	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					80	160	240											100	200	300				80	160	160				100				100			3.33	2.66		3.33	2.66	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	2	0	1	18	6	H2150_002_0	16	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1616	33	33	33				1616	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	2	0	1	18	6	H2150_002_0	16	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	2	0	1	18	6	H2150_002_0	16	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2150	9	0	1	18	6	H2150_009_0	18	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					7	14	21											10	20	30				7	0	0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	9	0	1	18	6	H2150_009_0	18	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	9	0	1	18	6	H2150_009_0	18	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	90				47				47			1.56	1.5		1.56	1.5	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	9	0	1	18	6	H2150_009_0	18	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	190				100				100			3.33	3.16		3.33	3.16	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	9	0	1	18	6	H2150_009_0	18	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1466	25	25	25				1466	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	9	0	1	18	6	H2150_009_0	18	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	9	0	1	18	6	H2150_009_0	18	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2150	29	0	2	18	6	H2150_029_0	14	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					7	14	21											10	20	30				7	0	0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	29	0	2	18	6	H2150_029_0	14	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	29	0	2	18	6	H2150_029_0	14	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	90				47				47			1.56	1.5		1.56	1.5	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	29	0	2	18	6	H2150_029_0	14	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	190				100				100			3.33	3.16		3.33	3.16	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	29	0	2	18	6	H2150_029_0	14	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1524	25	25	25				1524	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	29	0	2	18	6	H2150_029_0	14	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2150	29	0	2	18	6	H2150_029_0	14	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2161	2	0	1	1	1	H2161_002_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	10																			5	7.5	7.5																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	2	0	1	1	1	H2161_002_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	20																			10	15	15																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	2	0	1	1	1	H2161_002_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	42	84	84																			42	63	63																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	2	0	1	1	1	H2161_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	190																			95	142.5	142.5																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	2	0	1	1	1	H2161_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	3	0	1	1	1	H2161_003_0	6	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	14																			7	10.5	10.5																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	3	0	1	1	1	H2161_003_0	6	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	13	26	26																			13	19.5	19.5																13				13		0.43			0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	3	0	1	1	1	H2161_003_0	6	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	47	94	94																			47	70.5	70.5																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	3	0	1	1	1	H2161_003_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	100	200	200																			100	150	150																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2161	3	0	1	1	1	H2161_003_0	6	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	1	0	1	1	1	H2162_001_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	1	0	1	1	1	H2162_001_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	1	0	1	1	1	H2162_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	1	0	1	1	1	H2162_001_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				72.36	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	1	0	1	1	1	H2162_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					30																										30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	2	0	1	1	1	H2162_002_0	8	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	2	0	1	1	1	H2162_002_0	8	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	2	0	1	1	1	H2162_002_0	8	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	2	0	1	1	1	H2162_002_0	8	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.65	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2162	2	0	1	1	1	H2162_002_0	8	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2171	1	0	1	1	1	H2171_001_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2171	1	0	1	1	1	H2171_001_0	3	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2171	1	0	1	1	1	H2171_001_0	3	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10	20	20																			10	20	20																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2171	1	0	1	1	1	H2171_001_0	3	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10	20	20																			10	20	20																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2171	1	0	1	1	1	H2171_001_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40	80	80																			40	80	80																	40			40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2171	1	0	1	1	1	H2171_001_0	3	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40	80	80																			40	80	80																	40			40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2171	1	0	1	1	1	H2171_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	95	190	190																			95	190	190																	95			95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2171	1	0	1	1	1	H2171_001_0	3	Specialty Tier	4	11	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"												
H2172	1	0	1	1	1	H2172_001_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	1	0	1	1	1	H2172_001_0	8	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	1	0	1	1	1	H2172_001_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	1	0	1	1	1	H2172_001_0	8	Generic	4	11	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	1	0	1	1	1	H2172_001_0	8	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	84				47				47			1.56	1.4		1.56	1.4	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	1	0	1	1	1	H2172_001_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					80	160	240											100	200	300				80	160	160				100				100			3.33	2.66		3.33	2.66	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	1	0	1	1	1	H2172_001_0	8	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1719	33	33	33				1719	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	1	0	1	1	1	H2172_001_0	8	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	1	0	1	1	1	H2172_001_0	8	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	2	0	1	1	1	H2172_002_0	11	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	2	0	1	1	1	H2172_002_0	11	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	2	0	1	1	1	H2172_002_0	11	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	2	0	1	1	1	H2172_002_0	11	Generic	4	11	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	2	0	1	1	1	H2172_002_0	11	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	84				47				47			1.56	1.4		1.56	1.4	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	2	0	1	1	1	H2172_002_0	11	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					80	160	240											100	200	300				80	160	160				100				100			3.33	2.66		3.33	2.66	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	2	0	1	1	1	H2172_002_0	11	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1438	33	33	33				1438	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	2	0	1	1	1	H2172_002_0	11	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	2	0	1	1	1	H2172_002_0	11	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	3	0	1	1	1	H2172_003_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	3	0	1	1	1	H2172_003_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	3	0	1	1	1	H2172_003_0	8	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	90				47				47			1.56	1.5		1.56	1.5	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	3	0	1	1	1	H2172_003_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					100	200	300											100	200	300				100	200	200				100				100			3.33	3.33		3.33	3.33	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	3	0	1	1	1	H2172_003_0	8	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1457	33	33	33				1457	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	3	0	1	1	1	H2172_003_0	8	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	3	0	1	1	1	H2172_003_0	8	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	4	0	1	1	1	H2172_004_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	4	0	1	1	1	H2172_004_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	4	0	1	1	1	H2172_004_0	8	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	90				47				47			1.56	1.5		1.56	1.5	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	4	0	1	1	1	H2172_004_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					100	200	300											100	200	300				100	200	200				100				100			3.33	3.33		3.33	3.33	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	4	0	1	1	1	H2172_004_0	8	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1654	33	33	33				1654	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	4	0	1	1	1	H2172_004_0	8	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	4	0	1	1	1	H2172_004_0	8	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	6	0	1	1	1	H2172_006_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	6	0	1	1	1	H2172_006_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	6	0	1	1	1	H2172_006_0	8	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	90				47				47			1.56	1.5		1.56	1.5	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	6	0	1	1	1	H2172_006_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					100	200	300											100	200	300				100	200	200				100				100			3.33	3.33		3.33	3.33	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	6	0	1	1	1	H2172_006_0	8	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1537	33	33	33				1537	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	6	0	1	1	1	H2172_006_0	8	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	6	0	1	1	1	H2172_006_0	8	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	8	0	1	1	1	H2172_008_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	8	0	1	1	1	H2172_008_0	8	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	8	0	1	1	1	H2172_008_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	8	0	1	1	1	H2172_008_0	8	Generic	4	11	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	8	0	1	1	1	H2172_008_0	8	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	84				47				47			1.56	1.4		1.56	1.4	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	8	0	1	1	1	H2172_008_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					80	160	240											100	200	300				80	160	160				100				100			3.33	2.66		3.33	2.66	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	8	0	1	1	1	H2172_008_0	8	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1684	33	33	33				1684	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	8	0	1	1	1	H2172_008_0	8	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	8	0	1	1	1	H2172_008_0	8	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	9	0	1	1	1	H2172_009_0	9	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					3	6	9											10	20	30				3	0	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	9	0	1	1	1	H2172_009_0	9	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	36											20	40	60				12	24	24				20				20			0.66	0.4		0.66	0.4	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	9	0	1	1	1	H2172_009_0	9	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	90				47				47			1.56	1.5		1.56	1.5	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	9	0	1	1	1	H2172_009_0	9	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					100	200	300											100	200	300				100	200	200				100				100			3.33	3.33		3.33	3.33	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	9	0	1	1	1	H2172_009_0	9	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1493	33	33	33				1493	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	9	0	1	1	1	H2172_009_0	9	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	9	0	1	1	1	H2172_009_0	9	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2172	10	0	1	1	1	H2172_010_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	30					5	10	15											10	20	30				5	0	0				10				10			0.33	0.16		0.33	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	10	0	1	1	1	H2172_010_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	45											20	40	60				15	30	30				20				20			0.66	0.5		0.66	0.5	0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	10	0	1	1	1	H2172_010_0	8	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	90				47				47			1.56	1.5		1.56	1.5	1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	10	0	1	1	1	H2172_010_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					100	200	300											100	200	300				100	200	200				100				100			3.33	3.33		3.33	3.33	3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	10	0	1	1	1	H2172_010_0	8	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											1493	33	33	33				1493	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	10	0	1	1	1	H2172_010_0	8	Vaccines	4	10	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H2172	10	0	1	1	1	H2172_010_0	8	Vaccines	4	10	1	2	6	3		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H2228	11	0	1	4	1	H2228_011_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	11	0	1	4	1	H2228_011_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	11	0	1	4	1	H2228_011_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	11	0	1	4	1	H2228_011_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	11	0	1	4	1	H2228_011_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				800	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	17	0	1	4	1	H2228_017_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	17	0	1	4	1	H2228_017_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	17	0	1	4	1	H2228_017_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	17	0	1	4	1	H2228_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	17	0	1	4	1	H2228_017_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				716	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	18	0	1	4	1	H2228_018_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	18	0	1	4	1	H2228_018_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	18	0	1	4	1	H2228_018_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	18	0	1	4	1	H2228_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	18	0	1	4	1	H2228_018_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1041	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	19	0	1	4	1	H2228_019_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	19	0	1	4	1	H2228_019_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	19	0	1	4	1	H2228_019_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	19	0	1	4	1	H2228_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	19	0	1	4	1	H2228_019_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				893	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	20	0	1	4	1	H2228_020_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	20	0	1	4	1	H2228_020_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	20	0	1	4	1	H2228_020_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	20	0	1	4	1	H2228_020_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	20	0	1	4	1	H2228_020_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				801	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	21	0	1	4	1	H2228_021_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	21	0	1	4	1	H2228_021_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	21	0	1	4	1	H2228_021_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	21	0	1	4	1	H2228_021_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	21	0	1	4	1	H2228_021_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				829	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	22	0	1	4	1	H2228_022_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	22	0	1	4	1	H2228_022_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	22	0	1	4	1	H2228_022_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	22	0	1	4	1	H2228_022_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	22	0	1	4	1	H2228_022_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				887	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	23	0	1	4	1	H2228_023_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	23	0	1	4	1	H2228_023_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		28																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	23	0	1	4	1	H2228_023_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	23	0	1	4	1	H2228_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	23	0	1	4	1	H2228_023_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				805	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	24	0	1	4	1	H2228_024_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	24	0	1	4	1	H2228_024_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	24	0	1	4	1	H2228_024_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	24	0	1	4	1	H2228_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	24	0	1	4	1	H2228_024_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				634	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	29	0	1	4	1	H2228_029_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	29	0	1	4	1	H2228_029_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	29	0	1	4	1	H2228_029_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	29	0	1	4	1	H2228_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	29	0	1	4	1	H2228_029_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				807	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	30	0	1	4	1	H2228_030_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		5																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	30	0	1	4	1	H2228_030_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		20																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	30	0	1	4	1	H2228_030_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	30	0	1	4	1	H2228_030_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	30	0	1	4	1	H2228_030_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				789	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	31	0	1	4	1	H2228_031_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	31	0	1	4	1	H2228_031_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	31	0	1	4	1	H2228_031_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	31	0	1	4	1	H2228_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	31	0	1	4	1	H2228_031_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				721	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	32	0	1	4	1	H2228_032_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	32	0	1	4	1	H2228_032_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	32	0	1	4	1	H2228_032_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	32	0	1	4	1	H2228_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	32	0	1	4	1	H2228_032_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				896	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	35	0	1	4	1	H2228_035_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	35	0	1	4	1	H2228_035_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	35	0	1	4	1	H2228_035_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	35	0	1	4	1	H2228_035_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	35	0	1	4	1	H2228_035_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				763	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	36	0	1	4	1	H2228_036_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	36	0	1	4	1	H2228_036_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	36	0	1	4	1	H2228_036_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	36	0	1	4	1	H2228_036_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	36	0	1	4	1	H2228_036_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				786	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	37	0	1	4	1	H2228_037_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	37	0	1	4	1	H2228_037_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2228	37	0	1	4	1	H2228_037_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	37	0	1	4	1	H2228_037_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2228	37	0	1	4	1	H2228_037_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	37	0	1	4	1	H2228_037_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	37	0	1	4	1	H2228_037_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				816	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	39	0	1	4	1	H2228_039_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	39	0	1	4	1	H2228_039_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	39	0	1	4	1	H2228_039_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	39	0	1	4	1	H2228_039_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	39	0	1	4	1	H2228_039_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				619	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	47	0	1	4	1	H2228_047_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	47	0	1	4	1	H2228_047_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	47	0	1	4	1	H2228_047_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	47	0	1	4	1	H2228_047_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	47	0	1	4	1	H2228_047_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				966	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	49	0	1	4	1	H2228_049_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	49	0	1	4	1	H2228_049_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	49	0	1	4	1	H2228_049_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	49	0	1	4	1	H2228_049_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	49	0	1	4	1	H2228_049_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				819	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	64	0	1	4	1	H2228_064_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	64	0	1	4	1	H2228_064_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	64	0	1	4	1	H2228_064_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	64	0	1	4	1	H2228_064_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	64	0	1	4	1	H2228_064_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				858	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	65	0	1	4	1	H2228_065_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	65	0	1	4	1	H2228_065_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	65	0	1	4	1	H2228_065_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	65	0	1	4	1	H2228_065_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	65	0	1	4	1	H2228_065_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				858	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	66	0	1	4	1	H2228_066_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	66	0	1	4	1	H2228_066_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	66	0	1	4	1	H2228_066_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	66	0	1	4	1	H2228_066_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	66	0	1	4	1	H2228_066_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				832	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	67	0	1	4	1	H2228_067_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	67	0	1	4	1	H2228_067_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	67	0	1	4	1	H2228_067_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	67	0	1	4	1	H2228_067_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	67	0	1	4	1	H2228_067_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				726	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	68	0	1	4	1	H2228_068_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	68	0	1	4	1	H2228_068_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	68	0	1	4	1	H2228_068_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	68	0	1	4	1	H2228_068_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	68	0	1	4	1	H2228_068_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				678	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	71	0	1	4	1	H2228_071_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	71	0	1	4	1	H2228_071_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	71	0	1	4	1	H2228_071_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	71	0	1	4	1	H2228_071_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	71	0	1	4	1	H2228_071_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				883	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	74	0	1	4	1	H2228_074_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	74	0	1	4	1	H2228_074_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	74	0	1	4	1	H2228_074_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	74	0	1	4	1	H2228_074_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	74	0	1	4	1	H2228_074_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											866	29		29				724	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	75	0	1	4	1	H2228_075_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	75	0	1	4	1	H2228_075_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	75	0	1	4	1	H2228_075_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	75	0	1	4	1	H2228_075_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	75	0	1	4	1	H2228_075_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											749	28		28				763	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	76	0	1	4	1	H2228_076_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	76	0	1	4	1	H2228_076_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	76	0	1	4	1	H2228_076_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	76	0	1	4	1	H2228_076_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	76	0	1	4	1	H2228_076_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											757	27		27				729	27		27												27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	77	0	1	4	1	H2228_077_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	77	0	1	4	1	H2228_077_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	77	0	1	4	1	H2228_077_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	77	0	1	4	1	H2228_077_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	77	0	1	4	1	H2228_077_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											747	25		25				624	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	79	0	1	4	1	H2228_079_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	79	0	1	4	1	H2228_079_0	4	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	79	0	1	4	1	H2228_079_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	79	0	1	4	1	H2228_079_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	79	0	1	4	1	H2228_079_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											794	29		29				596	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	80	0	1	4	1	H2228_080_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	80	0	1	4	1	H2228_080_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	80	0	1	4	1	H2228_080_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	80	0	1	4	1	H2228_080_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	80	0	1	4	1	H2228_080_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				813	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	81	0	1	4	1	H2228_081_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						6				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	81	0	1	4	1	H2228_081_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						20				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	81	0	1	4	1	H2228_081_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	81	0	1	4	1	H2228_081_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	81	0	1	4	1	H2228_081_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				805	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	82	0	1	4	1	H2228_082_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	82	0	1	4	1	H2228_082_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	82	0	1	4	1	H2228_082_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	82	0	1	4	1	H2228_082_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	82	0	1	4	1	H2228_082_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				917	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	83	0	1	4	1	H2228_083_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	83	0	1	4	1	H2228_083_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	83	0	1	4	1	H2228_083_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	83	0	1	4	1	H2228_083_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	83	0	1	4	1	H2228_083_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											910	33		33				741	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	84	0	1	4	1	H2228_084_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	84	0	1	4	1	H2228_084_0	4	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	84	0	1	4	1	H2228_084_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	84	0	1	4	1	H2228_084_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	84	0	1	4	1	H2228_084_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											754	28		28				601	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	85	0	1	4	1	H2228_085_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	85	0	1	4	1	H2228_085_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	85	0	1	4	1	H2228_085_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	85	0	1	4	1	H2228_085_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	85	0	1	4	1	H2228_085_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				788	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	86	0	1	4	1	H2228_086_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	86	0	1	4	1	H2228_086_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	86	0	1	4	1	H2228_086_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	86	0	1	4	1	H2228_086_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2228	86	0	1	4	1	H2228_086_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				788	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2230	2	0	1	4	1	H2230_002_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	1	1																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	2	0	1	4	1	H2230_002_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	2	0	1	4	1	H2230_002_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	2	0	1	4	1	H2230_002_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	2	0	1	4	1	H2230_002_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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 Brand, Specialty Tier"												
H2230	17	0	1	4	1	H2230_017_0	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					4	8	12					4	4	4																10				10			0.33	0.13	0.13			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	17	0	1	4	1	H2230_017_0	5	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					10	20	30					10	20	20																16				16			0.53	0.33	0.33			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	17	0	1	4	1	H2230_017_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	17	0	1	4	1	H2230_017_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	17	0	1	4	1	H2230_017_0	5	Specialty Tier	4	11	1	1	5	1		111	1	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 Brand, Specialty Tier"												
H2230	18	1	1	4	1	H2230_018_1	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					2	4	6					2	2	2																8				8			0.27	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	1	1	4	1	H2230_018_1	5	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					6	12	18					6	12	12																12				12			0.4	0.2	0.2			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	1	1	4	1	H2230_018_1	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	1	1	4	1	H2230_018_1	5	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	1	1	4	1	H2230_018_1	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	2	1	4	1	H2230_018_2	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					2	4	6					2	2	2																8				8			0.27	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	2	1	4	1	H2230_018_2	5	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					6	12	18					6	12	12																12				12			0.4	0.2	0.2			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	2	1	4	1	H2230_018_2	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	2	1	4	1	H2230_018_2	5	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2230	18	2	1	4	1	H2230_018_2	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	1	0	1	1	1	H2235_001_0	7	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	1	0	1	1	1	H2235_001_0	7	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					0																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	1	0	1	1	1	H2235_001_0	7	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	35	70	105																					95																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	1	0	1	1	1	H2235_001_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	85	170	255																					245																85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	1	0	1	1	1	H2235_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				586.92	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	2	0	1	1	1	H2235_002_0	6	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	2	0	1	1	1	H2235_002_0	6	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					0																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	2	0	1	1	1	H2235_002_0	6	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					125																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	2	0	1	1	1	H2235_002_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					275																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2235	2	0	1	1	1	H2235_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				586.92	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2237	1	0	1	1	1	H2237_001_0	5	Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Generic, Brand, Specialty Tier"												
H2237	1	0	1	1	1	H2237_001_0	5	Brand	3	10	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Generic, Brand, Specialty Tier"												
H2237	1	0	1	1	1	H2237_001_0	5	Specialty Tier	3	11	1	1	3	1	10		1	10		1	30								30						30		31				1	25																				25																	25			25								"Generic, Brand, Specialty Tier"												
H2237	7	0	1	1	1	H2237_007_0	5	Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	36																12				12		0.4			0.4			0.39	"Generic, Brand, Specialty Tier"												
H2237	7	0	1	1	1	H2237_007_0	5	Brand	3	10	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	42	84	126																			42	84	126																42				42		1.4			1.4			1.35	"Generic, Brand, Specialty Tier"												
H2237	7	0	1	1	1	H2237_007_0	5	Specialty Tier	3	11	1	1	3	1	10		1	10		1	30								30						30		31				1	25																				25																	25			25								"Generic, Brand, Specialty Tier"												
H2237	9	0	1	1	1	H2237_009_0	5	Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	16	32	48																			16	32	48																16				16		0.53			0.53			0.52	"Generic, Brand, Specialty Tier"												
H2237	9	0	1	1	1	H2237_009_0	5	Brand	3	10	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	42	84	126																			42	84	126																42				42		1.4			1.4			1.35	"Generic, Brand, Specialty Tier"												
H2237	9	0	1	1	1	H2237_009_0	5	Specialty Tier	3	11	1	1	3	1	10		1	10		1	30								30						30		31				1	25																				25																	25			25								"Generic, Brand, Specialty Tier"												
H2237	11	0	1	1	1	H2237_011_0	5	Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Generic, Brand, Specialty Tier"												
H2237	11	0	1	1	1	H2237_011_0	5	Brand	3	10	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	48	96	144																			48	96	144																48				48		1.6			1.6			1.55	"Generic, Brand, Specialty Tier"												
H2237	11	0	1	1	1	H2237_011_0	5	Specialty Tier	3	11	1	1	3	1	10		1	10		1	30								30						30		31				1	25																				25																	25			25								"Generic, Brand, Specialty Tier"												
H2241	7	1	1	1	1	H2241_007_1	7	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	1	1	1	1	H2241_007_1	7	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	7	1	1	1	1	H2241_007_1	7	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	1	1	1	1	H2241_007_1	7	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	7	1	1	1	1	H2241_007_1	7	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	1	1	1	1	H2241_007_1	7	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	7	1	1	1	1	H2241_007_1	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	1	1	1	1	H2241_007_1	7	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	7	1	1	1	1	H2241_007_1	7	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	1	1	1	1	H2241_007_1	7	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	7	2	1	1	1	H2241_007_2	7	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	2	1	1	1	H2241_007_2	7	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	7	2	1	1	1	H2241_007_2	7	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	2	1	1	1	H2241_007_2	7	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	7	2	1	1	1	H2241_007_2	7	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	2	1	1	1	H2241_007_2	7	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	7	2	1	1	1	H2241_007_2	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	2	1	1	1	H2241_007_2	7	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	7	2	1	1	1	H2241_007_2	7	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	7	2	1	1	1	H2241_007_2	7	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	12	0	1	1	1	H2241_012_0	7	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	12	0	1	1	1	H2241_012_0	7	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	12	0	1	1	1	H2241_012_0	7	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	12	0	1	1	1	H2241_012_0	7	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	12	0	1	1	1	H2241_012_0	7	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	12	0	1	1	1	H2241_012_0	7	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	12	0	1	1	1	H2241_012_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	12	0	1	1	1	H2241_012_0	7	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	12	0	1	1	1	H2241_012_0	7	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	12	0	1	1	1	H2241_012_0	7	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	13	0	1	1	1	H2241_013_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	13	0	1	1	1	H2241_013_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	13	0	1	1	1	H2241_013_0	6	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	13	0	1	1	1	H2241_013_0	6	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	13	0	1	1	1	H2241_013_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	13	0	1	1	1	H2241_013_0	6	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	13	0	1	1	1	H2241_013_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	13	0	1	1	1	H2241_013_0	6	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	13	0	1	1	1	H2241_013_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	13	0	1	1	1	H2241_013_0	6	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	14	0	1	1	1	H2241_014_0	8	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	14	0	1	1	1	H2241_014_0	8	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	14	0	1	1	1	H2241_014_0	8	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	14	0	1	1	1	H2241_014_0	8	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	14	0	1	1	1	H2241_014_0	8	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	14	0	1	1	1	H2241_014_0	8	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	14	0	1	1	1	H2241_014_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	14	0	1	1	1	H2241_014_0	8	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	14	0	1	1	1	H2241_014_0	8	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	14	0	1	1	1	H2241_014_0	8	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	15	0	1	1	1	H2241_015_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	15	0	1	1	1	H2241_015_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	15	0	1	1	1	H2241_015_0	6	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	15	0	1	1	1	H2241_015_0	6	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	15	0	1	1	1	H2241_015_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	15	0	1	1	1	H2241_015_0	6	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	15	0	1	1	1	H2241_015_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	15	0	1	1	1	H2241_015_0	6	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	15	0	1	1	1	H2241_015_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	15	0	1	1	1	H2241_015_0	6	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	16	0	1	1	1	H2241_016_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	16	0	1	1	1	H2241_016_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	16	0	1	1	1	H2241_016_0	6	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	16	0	1	1	1	H2241_016_0	6	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	16	0	1	1	1	H2241_016_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	16	0	1	1	1	H2241_016_0	6	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	16	0	1	1	1	H2241_016_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	16	0	1	1	1	H2241_016_0	6	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	16	0	1	1	1	H2241_016_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	16	0	1	1	1	H2241_016_0	6	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	10		10																										15						10			10			10								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	17	0	1	1	1	H2241_017_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	17	0	1	1	1	H2241_017_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	5		15																											0						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	17	0	1	1	1	H2241_017_0	6	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	17	0	1	1	1	H2241_017_0	6	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	17	0	1	1	1	H2241_017_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	17	0	1	1	1	H2241_017_0	6	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	17	0	1	1	1	H2241_017_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	17	0	1	1	1	H2241_017_0	6	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	17	0	1	1	1	H2241_017_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	17	0	1	1	1	H2241_017_0	6	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	18	0	1	1	1	H2241_018_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	18	0	1	1	1	H2241_018_0	5	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	18	0	1	1	1	H2241_018_0	5	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	18	0	1	1	1	H2241_018_0	5	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	18	0	1	1	1	H2241_018_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	18	0	1	1	1	H2241_018_0	5	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	18	0	1	1	1	H2241_018_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	18	0	1	1	1	H2241_018_0	5	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	18	0	1	1	1	H2241_018_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	18	0	1	1	1	H2241_018_0	5	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	19	0	1	1	1	H2241_019_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	19	0	1	1	1	H2241_019_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	19	0	1	1	1	H2241_019_0	6	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	19	0	1	1	1	H2241_019_0	6	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	19	0	1	1	1	H2241_019_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	19	0	1	1	1	H2241_019_0	6	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	19	0	1	1	1	H2241_019_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	19	0	1	1	1	H2241_019_0	6	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	19	0	1	1	1	H2241_019_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	19	0	1	1	1	H2241_019_0	6	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	20	0	1	1	1	H2241_020_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	20	0	1	1	1	H2241_020_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	20	0	1	1	1	H2241_020_0	6	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	20	0	1	1	1	H2241_020_0	6	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	20	0	1	1	1	H2241_020_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	20	0	1	1	1	H2241_020_0	6	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	20	0	1	1	1	H2241_020_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	20	0	1	1	1	H2241_020_0	6	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	20	0	1	1	1	H2241_020_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	20	0	1	1	1	H2241_020_0	6	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	21	0	1	1	1	H2241_021_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	21	0	1	1	1	H2241_021_0	6	Preferred Generic	4	1	1	2	1	3	110		1		100	1	31		90				1	2						90	31		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	21	0	1	1	1	H2241_021_0	6	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	21	0	1	1	1	H2241_021_0	6	Generic	4	1	1	2	2	3	110		1		100	1	31		90				1	2						90	31		31	10		30																											0						0				10				10		0.32						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2241	21	0	1	1	1	H2241_021_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	21	0	1	1	1	H2241_021_0	6	Preferred Brand	4	11	1	2	3	3	110		1		100	1	31		90				1	2						90	31		31	45		135																											90						0				45				45		1.45						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	21	0	1	1	1	H2241_021_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	21	0	1	1	1	H2241_021_0	6	Non-Preferred Drug	4	11	1	2	4	3	110		1		100	1	31		90				1	2						90	31		31	95		285																											190						0				95				95		3.06						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2241	21	0	1	1	1	H2241_021_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	31		90				1	2						90	31		31				120.78	33		33																										33						15			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2241	21	0	1	1	1	H2241_021_0	6	Specialty Tier	4	11	1	1	5	3	110		1		100	1	31		90				1	2						90	31		31				1	15		15																										15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H2256	1	1	1	1	1	H2256_001_1	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	1	1	1	1	H2256_001_1	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H2256	1	1	1	1	1	H2256_001_1	8	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	1	1	1	1	H2256_001_1	8	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H2256	1	1	1	1	1	H2256_001_1	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	30	60	90																			30	60	60																30				30		1			1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	1	1	1	1	H2256_001_1	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	80	160	240																			80	160	240																80				80		2.67			2.67			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	1	1	1	1	H2256_001_1	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	1	1	1	1	H2256_001_1	8	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	2	1	1	1	H2256_001_2	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	2	1	1	1	H2256_001_2	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H2256	1	2	1	1	1	H2256_001_2	8	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	2	1	1	1	H2256_001_2	8	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H2256	1	2	1	1	1	H2256_001_2	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	30	60	90																			30	60	60																30				30		1			1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	2	1	1	1	H2256_001_2	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	80	160	240																			80	160	240																80				80		2.67			2.67			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	2	1	1	1	H2256_001_2	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	2	1	1	1	H2256_001_2	8	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	6	1	1	1	H2256_001_6	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	6	1	1	1	H2256_001_6	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H2256	1	6	1	1	1	H2256_001_6	8	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	6	1	1	1	H2256_001_6	8	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H2256	1	6	1	1	1	H2256_001_6	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	30	60	90																			30	60	60																30				30		1			1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	6	1	1	1	H2256_001_6	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	80	160	240																			80	160	240																80				80		2.67			2.67			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	6	1	1	1	H2256_001_6	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	1	6	1	1	1	H2256_001_6	8	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	1	1	1	1	H2256_015_1	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	1	1	1	1	H2256_015_1	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	1	1	1	1	H2256_015_1	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	1	1	1	1	H2256_015_1	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	1	1	1	1	H2256_015_1	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	1	1	1	1	H2256_015_1	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	2	1	1	1	H2256_015_2	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	2	1	1	1	H2256_015_2	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	2	1	1	1	H2256_015_2	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	2	1	1	1	H2256_015_2	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	2	1	1	1	H2256_015_2	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	2	1	1	1	H2256_015_2	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	6	1	1	1	H2256_015_6	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	6	1	1	1	H2256_015_6	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	6	1	1	1	H2256_015_6	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	6	1	1	1	H2256_015_6	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	6	1	1	1	H2256_015_6	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	15	6	1	1	1	H2256_015_6	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	1	1	1	1	H2256_018_1	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	1	1	1	1	H2256_018_1	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	1	1	1	1	H2256_018_1	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	1	1	1	1	H2256_018_1	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	1	1	1	1	H2256_018_1	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	1	1	1	1	H2256_018_1	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	7	1	1	1	H2256_018_7	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	7	1	1	1	H2256_018_7	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	7	1	1	1	H2256_018_7	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	7	1	1	1	H2256_018_7	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	7	1	1	1	H2256_018_7	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	7	1	1	1	H2256_018_7	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	8	1	1	1	H2256_018_8	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	8	1	1	1	H2256_018_8	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	8	1	1	1	H2256_018_8	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	8	1	1	1	H2256_018_8	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	8	1	1	1	H2256_018_8	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	18	8	1	1	1	H2256_018_8	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	1	1	1	1	H2256_026_1	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					0	0	0																14				0			0.47	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	1	1	1	1	H2256_026_1	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								19	38	57					4	8	12					4	8	8																19				4			0.63	0.13	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	1	1	1	1	H2256_026_1	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	1	1	1	1	H2256_026_1	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	1	1	1	1	H2256_026_1	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	1	1	1	1	H2256_026_1	7	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	2	1	1	1	H2256_026_2	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					0	0	0																14				0			0.47	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	2	1	1	1	H2256_026_2	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								19	38	57					4	8	12					4	8	8																19				4			0.63	0.13	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	2	1	1	1	H2256_026_2	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	2	1	1	1	H2256_026_2	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	2	1	1	1	H2256_026_2	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	2	1	1	1	H2256_026_2	7	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	3	1	1	1	H2256_026_3	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					0	0	0																14				0			0.47	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	3	1	1	1	H2256_026_3	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								19	38	57					4	8	12					4	8	8																19				4			0.63	0.13	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	3	1	1	1	H2256_026_3	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	3	1	1	1	H2256_026_3	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	3	1	1	1	H2256_026_3	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	26	3	1	1	1	H2256_026_3	7	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	28	0	1	1	1	H2256_028_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					0	0	0																14				0			0.47	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	28	0	1	1	1	H2256_028_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								19	38	57					4	8	12					4	8	8																19				4			0.63	0.13	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	28	0	1	1	1	H2256_028_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	28	0	1	1	1	H2256_028_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	28	0	1	1	1	H2256_028_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	28	0	1	1	1	H2256_028_0	7	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	33	0	1	1	1	H2256_033_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	33	0	1	1	1	H2256_033_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	33	0	1	1	1	H2256_033_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	33	0	1	1	1	H2256_033_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	33	0	1	1	1	H2256_033_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	33	0	1	1	1	H2256_033_0	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	34	0	1	1	1	H2256_034_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	34	0	1	1	1	H2256_034_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	16	16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	34	0	1	1	1	H2256_034_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	34	0	1	1	1	H2256_034_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	34	0	1	1	1	H2256_034_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	34	0	1	1	1	H2256_034_0	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	36	0	1	1	1	H2256_036_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					0	0	0																14				0			0.47	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	36	0	1	1	1	H2256_036_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								19	38	57					4	8	12					4	8	8																19				4			0.63	0.13	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	36	0	1	1	1	H2256_036_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	36	0	1	1	1	H2256_036_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	36	0	1	1	1	H2256_036_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2256	36	0	1	1	1	H2256_036_0	7	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H2261	5	0	1	1	1	H2261_005_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	1	1																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	5	0	1	1	1	H2261_005_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	5	0	1	1	1	H2261_005_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	5	0	1	1	1	H2261_005_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	5	0	1	1	1	H2261_005_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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 Brand, Specialty Tier"												
H2261	22	1	1	1	1	H2261_022_1	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					2	4	6					2	2	2																8				8			0.27	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	1	1	1	1	H2261_022_1	5	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					6	12	18					6	12	12																12				12			0.4	0.2	0.2			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	1	1	1	1	H2261_022_1	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	1	1	1	1	H2261_022_1	5	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	1	1	1	1	H2261_022_1	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	2	1	1	1	H2261_022_2	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					2	4	6					2	2	2																8				8			0.27	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	2	1	1	1	H2261_022_2	5	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					6	12	18					6	12	12																12				12			0.4	0.2	0.2			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	2	1	1	1	H2261_022_2	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	2	1	1	1	H2261_022_2	5	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	22	2	1	1	1	H2261_022_2	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	1	1	2	1	H2261_023_1	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	1	1																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	1	1	2	1	H2261_023_1	5	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	1	1	2	1	H2261_023_1	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	1	1	2	1	H2261_023_1	5	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	1	1	2	1	H2261_023_1	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	2	1	2	1	H2261_023_2	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	1	1																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	2	1	2	1	H2261_023_2	5	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	2	1	2	1	H2261_023_2	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	2	1	2	1	H2261_023_2	5	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	23	2	1	2	1	H2261_023_2	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	24	0	1	1	1	H2261_024_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					2	4	6					2	2	2																8				8			0.27	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	24	0	1	1	1	H2261_024_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					8	16	24					8	16	16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	24	0	1	1	1	H2261_024_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	24	0	1	1	1	H2261_024_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2261	24	0	1	1	1	H2261_024_0	6	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												26	26	26					26	26	26				26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2288	1	0	1	1	1	H2288_001_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	1	0	1	1	1	H2288_001_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		20																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	1	0	1	1	1	H2288_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	1	0	1	1	1	H2288_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	1	0	1	1	1	H2288_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				771.51	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	1	0	1	1	1	H2288_001_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	1	0	1	1	1	H2288_001_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2288	2	0	1	1	1	H2288_002_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	2	0	1	1	1	H2288_002_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	2	0	1	1	1	H2288_002_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	2	0	1	1	1	H2288_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	2	0	1	1	1	H2288_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				799.33	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	2	0	1	1	1	H2288_002_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	2	0	1	1	1	H2288_002_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2288	5	0	1	1	1	H2288_005_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	5	0	1	1	1	H2288_005_0	6	Generic	4	11	1	1	2	1	110		1	110		1	30		90				1	2	30		90				30		31				11.58	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	5	0	1	1	1	H2288_005_0	6	Preferred Brand	4	11	1	1	3	1	110		1	110		1	30		90				1	2	30		90				30		31				61.38	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	5	0	1	1	1	H2288_005_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				1	2	30		90				30		31				79.39	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	5	0	1	1	1	H2288_005_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				660.16	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	5	0	1	1	1	H2288_005_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	5	0	1	1	1	H2288_005_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2288	8	0	1	1	1	H2288_008_0	8	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	5		10																			5		10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	8	0	1	1	1	H2288_008_0	8	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	20		40																			20		40																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	8	0	1	1	1	H2288_008_0	8	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	8	0	1	1	1	H2288_008_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	8	0	1	1	1	H2288_008_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				707.61	27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	8	0	1	1	1	H2288_008_0	8	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2288	8	0	1	1	1	H2288_008_0	8	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2292	3	0	1	4	1	H2292_003_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2292	3	0	1	4	1	H2292_003_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2292	3	0	1	4	1	H2292_003_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2292	3	0	1	4	1	H2292_003_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2292	3	0	1	4	1	H2292_003_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				948	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	1	1	2	1	H2320_022_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					4	8	12					4	8	0																10				10			0.33	0.13	0.13			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	1	1	2	1	H2320_022_1	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	0																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	1	1	2	1	H2320_022_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	1	1	2	1	H2320_022_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											61.47	50	50	50				62.32	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	1	1	2	1	H2320_022_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	2	1	2	1	H2320_022_2	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					4	8	12					4	8	0																10				10			0.33	0.13	0.13			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	2	1	2	1	H2320_022_2	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	0																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	2	1	2	1	H2320_022_2	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	2	1	2	1	H2320_022_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											61.47	50	50	50				62.32	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	2	1	2	1	H2320_022_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	3	1	2	1	H2320_022_3	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					4	8	12					4	8	0																10				10			0.33	0.13	0.13			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	3	1	2	1	H2320_022_3	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	0																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	3	1	2	1	H2320_022_3	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	3	1	2	1	H2320_022_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											61.47	50	50	50				62.32	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	3	1	2	1	H2320_022_3	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	4	1	2	1	H2320_022_4	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					4	8	12					4	8	0																10				10			0.33	0.13	0.13			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	4	1	2	1	H2320_022_4	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	0																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	4	1	2	1	H2320_022_4	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	4	1	2	1	H2320_022_4	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											61.47	50	50	50				62.32	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	4	1	2	1	H2320_022_4	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	5	1	2	1	H2320_022_5	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					4	8	12					4	8	0																10				10			0.33	0.13	0.13			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	5	1	2	1	H2320_022_5	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	0																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	5	1	2	1	H2320_022_5	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	5	1	2	1	H2320_022_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											61.47	50	50	50				62.32	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	22	5	1	2	1	H2320_022_5	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	1	1	2	1	H2320_028_1	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	1	1	2	1	H2320_028_1	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								13	26	39					8	16	24					8	16	0																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	1	1	2	1	H2320_028_1	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								43	86	129					38	76	114					38	76	95																43				43			1.43	1.27	1.27			1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	1	1	2	1	H2320_028_1	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.14	45	45	45				31.51	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	1	1	2	1	H2320_028_1	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	2	1	2	1	H2320_028_2	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	2	1	2	1	H2320_028_2	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								13	26	39					8	16	24					8	16	0																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	2	1	2	1	H2320_028_2	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								43	86	129					38	76	114					38	76	95																43				43			1.43	1.27	1.27			1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	2	1	2	1	H2320_028_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.14	45	45	45				31.51	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	2	1	2	1	H2320_028_2	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	3	1	2	1	H2320_028_3	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	3	1	2	1	H2320_028_3	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								13	26	39					8	16	24					8	16	0																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	3	1	2	1	H2320_028_3	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								43	86	129					38	76	114					38	76	95																43				43			1.43	1.27	1.27			1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	3	1	2	1	H2320_028_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.14	45	45	45				31.51	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	3	1	2	1	H2320_028_3	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	4	1	2	1	H2320_028_4	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	4	1	2	1	H2320_028_4	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								13	26	39					8	16	24					8	16	0																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	4	1	2	1	H2320_028_4	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								43	86	129					38	76	114					38	76	95																43				43			1.43	1.27	1.27			1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	4	1	2	1	H2320_028_4	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.14	45	45	45				31.51	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	4	1	2	1	H2320_028_4	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	5	1	2	1	H2320_028_5	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	5	1	2	1	H2320_028_5	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								13	26	39					8	16	24					8	16	0																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	5	1	2	1	H2320_028_5	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								43	86	129					38	76	114					38	76	95																43				43			1.43	1.27	1.27			1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	5	1	2	1	H2320_028_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.14	45	45	45				31.51	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	28	5	1	2	1	H2320_028_5	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	1	1	2	1	H2320_029_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	1	1	2	1	H2320_029_1	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	1	1	2	1	H2320_029_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	1	1	2	1	H2320_029_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											38.64	50	50	50				36.86	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	1	1	2	1	H2320_029_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	2	1	2	1	H2320_029_2	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	2	1	2	1	H2320_029_2	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	2	1	2	1	H2320_029_2	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	2	1	2	1	H2320_029_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											38.64	50	50	50				36.86	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	2	1	2	1	H2320_029_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	3	1	2	1	H2320_029_3	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	3	1	2	1	H2320_029_3	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	3	1	2	1	H2320_029_3	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	3	1	2	1	H2320_029_3	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											38.64	50	50	50				36.86	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	3	1	2	1	H2320_029_3	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	4	1	2	1	H2320_029_4	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	4	1	2	1	H2320_029_4	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	4	1	2	1	H2320_029_4	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	4	1	2	1	H2320_029_4	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											38.64	50	50	50				36.86	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	4	1	2	1	H2320_029_4	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	5	1	2	1	H2320_029_5	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	5	1	2	1	H2320_029_5	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	5	1	2	1	H2320_029_5	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	5	1	2	1	H2320_029_5	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											38.64	50	50	50				36.86	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2320	29	5	1	2	1	H2320_029_5	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	4	0	1	4	1	H2322_004_0	8	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	17.5					0	0	0											7	14	17.5				0	0	0				7				0			0.23	0		0.23	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	4	0	1	4	1	H2322_004_0	8	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	4	0	1	4	1	H2322_004_0	8	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	4	0	1	4	1	H2322_004_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											90.31	42	42	42				82.54	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	4	0	1	4	1	H2322_004_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	8	0	1	4	1	H2322_008_0	7	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	17.5					0	0	0											7	14	17.5				0	0	0				7				0			0.23	0		0.23	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	8	0	1	4	1	H2322_008_0	7	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	8	0	1	4	1	H2322_008_0	7	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	8	0	1	4	1	H2322_008_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											98.89	42	42	42				87.3	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	8	0	1	4	1	H2322_008_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	11	0	1	4	1	H2322_011_0	7	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	17.5					0	0	0											7	14	17.5				0	0	0				7				0			0.23	0		0.23	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	11	0	1	4	1	H2322_011_0	7	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	11	0	1	4	1	H2322_011_0	7	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	11	0	1	4	1	H2322_011_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											73.62	42	42	42				61.9	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	11	0	1	4	1	H2322_011_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	12	0	1	4	1	H2322_012_0	7	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	17.5					0	0	0											7	14	17.5				0	0	0				7				0			0.23	0		0.23	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	12	0	1	4	1	H2322_012_0	7	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	12	0	1	4	1	H2322_012_0	7	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	12	0	1	4	1	H2322_012_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											66.77	42	42	42				55.56	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2322	12	0	1	4	1	H2322_012_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2334	1	0	1	4	1	H2334_001_0	9	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2334	1	0	1	4	1	H2334_001_0	9	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	15		45																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2334	1	0	1	4	1	H2334_001_0	9	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2334	1	0	1	4	1	H2334_001_0	9	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2334	1	0	1	4	1	H2334_001_0	9	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				652.83	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2334	1	0	1	4	1	H2334_001_0	9	Select Care Drugs	4	10	1	2	6	1	110		1	110		1	30		90				2	2	30		90				30		31	9		27																			9		18																9				9		0.3			0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2334	3	0	1	4	1	H2334_003_0	9	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2334	3	0	1	4	1	H2334_003_0	9	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2334	3	0	1	4	1	H2334_003_0	9	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2334	3	0	1	4	1	H2334_003_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	95		285																			95		190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2334	3	0	1	4	1	H2334_003_0	9	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				608.29	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	15	0	1	1	1	H2354_015_0	7	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	15	0	1	1	1	H2354_015_0	7	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	15	0	1	1	1	H2354_015_0	7	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	15	0	1	1	1	H2354_015_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											92.72	42	42	42				73.53	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	15	0	1	1	1	H2354_015_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	18	0	1	1	1	H2354_018_0	6	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	18	0	1	1	1	H2354_018_0	6	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	18	0	1	1	1	H2354_018_0	6	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	18	0	1	1	1	H2354_018_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											53.27	42	42	42				45.37	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	18	0	1	1	1	H2354_018_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	21	0	1	2	1	H2354_021_0	6	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	21	0	1	2	1	H2354_021_0	6	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	21	0	1	2	1	H2354_021_0	6	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	21	0	1	2	1	H2354_021_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											80.9	42	42	42				64.4	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	21	0	1	2	1	H2354_021_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	22	0	1	2	1	H2354_022_0	6	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	22	0	1	2	1	H2354_022_0	6	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	22	0	1	2	1	H2354_022_0	6	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	22	0	1	2	1	H2354_022_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											86.04	42	42	42				79.12	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	22	0	1	2	1	H2354_022_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	24	0	1	1	1	H2354_024_0	6	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	24	0	1	1	1	H2354_024_0	6	Preferred Generic	4	1	3	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2354	24	0	1	1	1	H2354_024_0	6	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	24	0	1	1	1	H2354_024_0	6	Generic	4	11	3	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2354	24	0	1	1	1	H2354_024_0	6	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	24	0	1	1	1	H2354_024_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											74.74	42	42	42				60.56	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	24	0	1	1	1	H2354_024_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	26	0	1	1	1	H2354_026_0	6	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	26	0	1	1	1	H2354_026_0	6	Preferred Generic	4	1	3	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2354	26	0	1	1	1	H2354_026_0	6	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	26	0	1	1	1	H2354_026_0	6	Generic	4	11	3	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2354	26	0	1	1	1	H2354_026_0	6	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	26	0	1	1	1	H2354_026_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											85.77	42	42	42				76.46	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	26	0	1	1	1	H2354_026_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	27	0	1	1	1	H2354_027_0	6	Preferred Generic	4	1	3	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	27	0	1	1	1	H2354_027_0	6	Preferred Generic	4	1	3	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	15					0	0	0											6	12	15				0	0	0				6				0			0.2	0		0.2	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2354	27	0	1	1	1	H2354_027_0	6	Generic	4	11	3	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	27	0	1	1	1	H2354_027_0	6	Generic	4	11	3	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					10	20	25											15	30	37.5				10	20	0				15				10			0.5	0.33		0.5	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H2354	27	0	1	1	1	H2354_027_0	6	Preferred Brand	4	10	3	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	117.5					42	84	105											47	94	117.5				42	84	105				47				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	27	0	1	1	1	H2354_027_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											85.38	42	42	42				76.14	40	40	40										42	42	42				40	40	40			42			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2354	27	0	1	1	1	H2354_027_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2392	2	0	1	1	1	H2392_002_0	3	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								14	31	4	8	12																																						4			4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2392	2	0	1	1	1	H2392_002_0	3	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								14	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2392	2	0	1	1	1	H2392_002_0	3	Preferred Brand	4	11	1	2	3	1	111		10			1	30	60	90				1	2								14	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2392	2	0	1	1	1	H2392_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10			1	30	60	90				1	2								14	31	98	196	294																																						98			98		3.27						3.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2392	2	0	1	1	1	H2392_002_0	3	Specialty Tier	4	11	1	1	5	1	10		10			1	30															14	31					25																																						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	8	0	1	4	1	H2406_008_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	8	0	1	4	1	H2406_008_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	8	0	1	4	1	H2406_008_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	8	0	1	4	1	H2406_008_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	8	0	1	4	1	H2406_008_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				927	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	9	0	1	4	1	H2406_009_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	9	0	1	4	1	H2406_009_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	9	0	1	4	1	H2406_009_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	9	0	1	4	1	H2406_009_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	9	0	1	4	1	H2406_009_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				908	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	10	0	1	4	1	H2406_010_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	10	0	1	4	1	H2406_010_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	10	0	1	4	1	H2406_010_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	10	0	1	4	1	H2406_010_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	10	0	1	4	1	H2406_010_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				764	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	11	0	1	4	1	H2406_011_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	11	0	1	4	1	H2406_011_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	11	0	1	4	1	H2406_011_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	11	0	1	4	1	H2406_011_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	11	0	1	4	1	H2406_011_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1025	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	12	0	1	4	1	H2406_012_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	12	0	1	4	1	H2406_012_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	12	0	1	4	1	H2406_012_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	12	0	1	4	1	H2406_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	12	0	1	4	1	H2406_012_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				888	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	13	0	1	4	1	H2406_013_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	13	0	1	4	1	H2406_013_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	13	0	1	4	1	H2406_013_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	13	0	1	4	1	H2406_013_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	13	0	1	4	1	H2406_013_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				729	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	14	0	1	4	1	H2406_014_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	14	0	1	4	1	H2406_014_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	14	0	1	4	1	H2406_014_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	14	0	1	4	1	H2406_014_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	14	0	1	4	1	H2406_014_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				858	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	15	0	1	4	1	H2406_015_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	15	0	1	4	1	H2406_015_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	15	0	1	4	1	H2406_015_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	15	0	1	4	1	H2406_015_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	15	0	1	4	1	H2406_015_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				948	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	16	0	1	4	1	H2406_016_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	16	0	1	4	1	H2406_016_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	16	0	1	4	1	H2406_016_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	16	0	1	4	1	H2406_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	16	0	1	4	1	H2406_016_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1158	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	17	0	1	4	1	H2406_017_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	17	0	1	4	1	H2406_017_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	17	0	1	4	1	H2406_017_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	17	0	1	4	1	H2406_017_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	17	0	1	4	1	H2406_017_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				888	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	18	0	1	4	1	H2406_018_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	18	0	1	4	1	H2406_018_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	18	0	1	4	1	H2406_018_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H2406	18	0	1	4	1	H2406_018_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	18	0	1	4	1	H2406_018_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	18	0	1	4	1	H2406_018_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				747	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	19	0	1	4	1	H2406_019_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	19	0	1	4	1	H2406_019_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	19	0	1	4	1	H2406_019_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	19	0	1	4	1	H2406_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	19	0	1	4	1	H2406_019_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				888	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	20	0	1	4	1	H2406_020_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	20	0	1	4	1	H2406_020_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	20	0	1	4	1	H2406_020_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H2406	20	0	1	4	1	H2406_020_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	20	0	1	4	1	H2406_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2406	20	0	1	4	1	H2406_020_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				747	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2446	1	0	1	2	1	H2446_001_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	5	10	15																			5	0	0																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	1	0	1	2	1	H2446_001_0	3	Generic	4	1	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	10	20	30																			10	20	20																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	1	0	1	2	1	H2446_001_0	3	Preferred Brand	4	11	1	1	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				26.39	20	20	20																		20	20	20															20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	1	0	1	2	1	H2446_001_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				50.47	39	39	39																		39	39	39															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	1	0	1	2	1	H2446_001_0	3	Specialty Tier	4	11	1	1	5	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	1	0	1	2	1	H2446_001_0	3	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			5	0	0																0				0		0			0.16			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	2	0	1	2	1	H2446_002_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	4	8	12																			4	0	0																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	2	0	1	2	1	H2446_002_0	3	Generic	4	1	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	9	18	27																			9	18	18																9				9		0.29			0.29			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	2	0	1	2	1	H2446_002_0	3	Preferred Brand	4	11	1	1	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				26.63	20	20	20																		20	20	20															20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	2	0	1	2	1	H2446_002_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				50.64	39	39	39																		39	39	39															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	2	0	1	2	1	H2446_002_0	3	Specialty Tier	4	11	1	1	5	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2446	2	0	1	2	1	H2446_002_0	3	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			4	0	0																0				0		0			0.13			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2450	1	0	1	18	6	H2450_001_0	6	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					2		6							4																10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	1	0	1	18	6	H2450_001_0	6	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					8		24							16																20				20			0.67	0.27				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	1	0	1	18	6	H2450_001_0	6	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					35		105							70																47				47			1.57	1.17				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	1	0	1	18	6	H2450_001_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											58.37	50		50				58.3	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	1	0	1	18	6	H2450_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	2	0	1	18	6	H2450_002_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					2		6							4																10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	2	0	1	18	6	H2450_002_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					8		24							16																20				20			0.67	0.27				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	2	0	1	18	6	H2450_002_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					35		105							70																47				47			1.57	1.17				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	2	0	1	18	6	H2450_002_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											64.72	50		50				64.75	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	2	0	1	18	6	H2450_002_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	7	0	1	18	6	H2450_007_0	6	Preferred Generic	3	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					4		12							8																10				10			0.33	0.13				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	7	0	1	18	6	H2450_007_0	6	Generic	3	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					12		36							24																20				20			0.67	0.4				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	7	0	1	18	6	H2450_007_0	6	Preferred Brand	3	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					40		120							80																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	7	0	1	18	6	H2450_007_0	6	Non-Preferred Drug	3	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											65.02	50		50				71.79	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	7	0	1	18	6	H2450_007_0	6	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	16	0	1	18	6	H2450_016_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	16	0	1	18	6	H2450_016_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	16	0	1	18	6	H2450_016_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					33		99							66																47				47			1.57	1.1				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	16	0	1	18	6	H2450_016_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											52.33	50		50				49.93	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	16	0	1	18	6	H2450_016_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	17	0	1	18	6	H2450_017_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	17	0	1	18	6	H2450_017_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	17	0	1	18	6	H2450_017_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					33		99							66																47				47			1.57	1.1				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	17	0	1	18	6	H2450_017_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											46.97	50		50				42.26	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	17	0	1	18	6	H2450_017_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	22	0	1	18	6	H2450_022_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					2		6							4																10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	22	0	1	18	6	H2450_022_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	22	0	1	18	6	H2450_022_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					30		90							60																47				47			1.57	1				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	22	0	1	18	6	H2450_022_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											56.37	50		50				59.52	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	22	0	1	18	6	H2450_022_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	35	0	1	18	6	H2450_035_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					1		3							2																10				10			0.33	0.03				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	35	0	1	18	6	H2450_035_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					8		24							16																20				20			0.67	0.27				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	35	0	1	18	6	H2450_035_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					30		90							60																47				47			1.57	1				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	35	0	1	18	6	H2450_035_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											55.52	50		50				62.38	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	35	0	1	18	6	H2450_035_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	37	0	1	18	6	H2450_037_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	37	0	1	18	6	H2450_037_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					7		21							14																20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	37	0	1	18	6	H2450_037_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					28		84							56																47				47			1.57	0.93				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	37	0	1	18	6	H2450_037_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											47.57	50		50				53.26	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	37	0	1	18	6	H2450_037_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	39	0	1	18	6	H2450_039_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					2		6							4																10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	39	0	1	18	6	H2450_039_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	39	0	1	18	6	H2450_039_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					40		120							80																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	39	0	1	18	6	H2450_039_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											78.06	50		50				66.69	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	39	0	1	18	6	H2450_039_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	41	0	1	18	6	H2450_041_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	41	0	1	18	6	H2450_041_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	41	0	1	18	6	H2450_041_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					40		120							80																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	41	0	1	18	6	H2450_041_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											54.5	50		50				64.25	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2450	41	0	1	18	6	H2450_041_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	20	0	1	2	1	H2459_020_0	3	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					3		9											12		24				3		6					12			12			0.4	0.1		0.4	0.1	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	20	0	1	2	1	H2459_020_0	3	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					10		30											20		40				10		20					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	20	0	1	2	1	H2459_020_0	3	Preferred Brand	4	10	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											105	25		25				72	17		17										25		25				17		17				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	20	0	1	2	1	H2459_020_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											47	50		50				42	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	20	0	1	2	1	H2459_020_0	3	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											932	25		25				932	25		25										25		25				25		25				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	1	1	2	1	H2459_021_1	5	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10		30					0		0											10		20				0		0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	1	1	2	1	H2459_021_1	5	Preferred Generic	4	1	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								10		30					0		0											10		20				0		0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	21	1	1	2	1	H2459_021_1	5	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17		51					7		21											17		34				7		14					17			17			0.57	0.23		0.57	0.23	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	1	1	2	1	H2459_021_1	5	Generic	4	1	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								17		51					7		21											17		34				7		14					17			17			0.57	0.23		0.57	0.23	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	21	1	1	2	1	H2459_021_1	5	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45		135					35		105											45		90				35		70					45			45			1.5	1.17		1.5	1.17	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	1	1	2	1	H2459_021_1	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											54	50		50				48	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	1	1	2	1	H2459_021_1	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1534	29		29				1534	29		29										29		29				29		29				29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	2	1	2	1	H2459_021_2	4	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10		30					0		0											10		20				0		0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	2	1	2	1	H2459_021_2	4	Preferred Generic	4	1	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								10		30					0		0											10		20				0		0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	21	2	1	2	1	H2459_021_2	4	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17		51					7		21											17		34				7		14					17			17			0.57	0.23		0.57	0.23	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	2	1	2	1	H2459_021_2	4	Generic	4	1	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								17		51					7		21											17		34				7		14					17			17			0.57	0.23		0.57	0.23	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	21	2	1	2	1	H2459_021_2	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45		135					35		105											45		90				35		70					45			45			1.5	1.17		1.5	1.17	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	2	1	2	1	H2459_021_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											54	50		50				48	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	2	1	2	1	H2459_021_2	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1534	29		29				1534	29		29										29		29				29		29				29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	3	1	2	1	H2459_021_3	5	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10		30					0		0											10		20				0		0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	3	1	2	1	H2459_021_3	5	Preferred Generic	4	1	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								10		30					0		0											10		20				0		0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	21	3	1	2	1	H2459_021_3	5	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17		51					7		21											17		34				7		14					17			17			0.57	0.23		0.57	0.23	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	3	1	2	1	H2459_021_3	5	Generic	4	1	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								17		51					7		21											17		34				7		14					17			17			0.57	0.23		0.57	0.23	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	21	3	1	2	1	H2459_021_3	5	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45		135					35		105											45		90				35		70					45			45			1.5	1.17		1.5	1.17	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	3	1	2	1	H2459_021_3	5	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											54	50		50				48	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	21	3	1	2	1	H2459_021_3	5	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1534	29		29				1534	29		29										29		29				29		29				29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	1	1	2	1	H2459_023_1	4	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					2		6											12		24				2		4					12			12			0.4	0.07		0.4	0.07	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	1	1	2	1	H2459_023_1	4	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					10		30											20		40				10		20					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	1	1	2	1	H2459_023_1	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47		141					47		141											47		94				47		94					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	1	1	2	1	H2459_023_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											46	50		50				41	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	1	1	2	1	H2459_023_1	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1331	25		25				1331	25		25										25		25				25		25				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	2	1	2	1	H2459_023_2	4	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					2		6											12		24				2		4					12			12			0.4	0.07		0.4	0.07	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	2	1	2	1	H2459_023_2	4	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					10		30											20		40				10		20					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	2	1	2	1	H2459_023_2	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47		141					47		141											47		94				47		94					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	2	1	2	1	H2459_023_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											46	50		50				41	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	23	2	1	2	1	H2459_023_2	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1331	25		25				1331	25		25										25		25				25		25				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	24	0	1	2	1	H2459_024_0	3	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					3		9											12		24				3		6					12			12			0.4	0.1		0.4	0.1	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	24	0	1	2	1	H2459_024_0	3	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					10		30											20		40				10		20					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	24	0	1	2	1	H2459_024_0	3	Preferred Brand	4	10	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											95	25		25				64	17		17										25		25				17		17				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	24	0	1	2	1	H2459_024_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											40	50		50				36	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	24	0	1	2	1	H2459_024_0	3	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1187	25		25				1187	25		25										25		25				25		25				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	1	1	2	1	H2459_025_1	4	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								5		15					0		0											5		10				0		0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	1	1	2	1	H2459_025_1	4	Preferred Generic	4	1	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								5		15					0		0											5		10				0		0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	25	1	1	2	1	H2459_025_1	4	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					7		21											12		24				7		14					12			12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	1	1	2	1	H2459_025_1	4	Generic	4	1	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								12		36					7		21											12		24				7		14					12			12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	25	1	1	2	1	H2459_025_1	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40		120					35		105											40		80				35		70					40			40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	1	1	2	1	H2459_025_1	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											55	50		50				50	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	1	1	2	1	H2459_025_1	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1571	31		31				1571	31		31										31		31				31		31				31		31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	2	1	2	1	H2459_025_2	4	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								5		15					0		0											5		10				0		0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	2	1	2	1	H2459_025_2	4	Preferred Generic	4	1	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								5		15					0		0											5		10				0		0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	25	2	1	2	1	H2459_025_2	4	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					7		21											12		24				7		14					12			12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	2	1	2	1	H2459_025_2	4	Generic	4	1	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								12		36					7		21											12		24				7		14					12			12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	25	2	1	2	1	H2459_025_2	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40		120					35		105											40		80				35		70					40			40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	2	1	2	1	H2459_025_2	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											55	50		50				50	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	2	1	2	1	H2459_025_2	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1571	31		31				1571	31		31										31		31				31		31				31		31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	3	1	2	1	H2459_025_3	4	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								5		15					0		0											5		10				0		0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	3	1	2	1	H2459_025_3	4	Preferred Generic	4	1	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								5		15					0		0											5		10				0		0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	25	3	1	2	1	H2459_025_3	4	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					7		21											12		24				7		14					12			12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	3	1	2	1	H2459_025_3	4	Generic	4	1	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								12		36					7		21											12		24				7		14					12			12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2459	25	3	1	2	1	H2459_025_3	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								40		120					35		105											40		80				35		70					40			40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	3	1	2	1	H2459_025_3	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											55	50		50				50	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	25	3	1	2	1	H2459_025_3	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1571	31		31				1571	31		31										31		31				31		31				31		31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	1	1	2	1	H2459_026_1	3	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					3		9											12		24				3		6					12			12			0.4	0.1		0.4	0.1	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	1	1	2	1	H2459_026_1	3	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					10		30											20		40				10		20					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	1	1	2	1	H2459_026_1	3	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47		141					40		120											47		94				40		80					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	1	1	2	1	H2459_026_1	3	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											46	50		50				42	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	1	1	2	1	H2459_026_1	3	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1565	28		28				1565	28		28										28		28				28		28				28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	3	1	2	1	H2459_026_3	4	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12		36					3		9											12		24				3		6					12			12			0.4	0.1		0.4	0.1	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	3	1	2	1	H2459_026_3	4	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					10		30											20		40				10		20					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	3	1	2	1	H2459_026_3	4	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47		141					40		120											47		94				40		80					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	3	1	2	1	H2459_026_3	4	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											46	50		50				42	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2459	26	3	1	2	1	H2459_026_3	4	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1565	28		28				1565	28		28										28		28				28		28				28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2461	8	0	1	18	6	H2461_008_0	4	Preferred Generic	2	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								13	26	26					6	12	12					6	0	0																13				13			0.42	0.19	0.19			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	8	0	1	18	6	H2461_008_0	4	Generic	2	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								19	38	38					12	24	24					12	24	24																19				19			0.61	0.39	0.39			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	8	0	1	18	6	H2461_008_0	4	Preferred Brand	2	11	1	1	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											54.29	23	23	23				44.03	18	18	18				18	18	18															23			23								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	8	0	1	18	6	H2461_008_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											68.47	50	50	50				64.88	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	8	0	1	18	6	H2461_008_0	4	Specialty Tier	2	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	8	0	1	18	6	H2461_008_0	4	Select Care Drugs	2	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					6	0	0																5				5			0.16	0	0.19			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	9	0	1	18	6	H2461_009_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								12	24	24					5	10	10					5	0	0																12				12			0.39	0.16	0.16			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	9	0	1	18	6	H2461_009_0	4	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								17	34	34					10	20	20					10	20	20																17				17			0.55	0.32	0.32			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	9	0	1	18	6	H2461_009_0	4	Preferred Brand	4	11	1	1	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											52.92	23	23	23				41.55	18	18	18				18	18	18															23			23								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	9	0	1	18	6	H2461_009_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											64.69	50	50	50				70.22	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	9	0	1	18	6	H2461_009_0	4	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	9	0	1	18	6	H2461_009_0	4	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					5	0	0																5				5			0.16	0	0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	10	0	1	18	6	H2461_010_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								10	20	20					3	6	6					3	0	0																10				10			0.32	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	10	0	1	18	6	H2461_010_0	6	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								16	32	32					9	18	18					9	18	18																16				16			0.52	0.29	0.29			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	10	0	1	18	6	H2461_010_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											41.68	20	20	20				31.56	15	15	15				15	15	15															20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	10	0	1	18	6	H2461_010_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											80.16	50	50	50				46.24	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	10	0	1	18	6	H2461_010_0	6	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2461	10	0	1	18	6	H2461_010_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					3	0	0																5				5			0.16	0	0.1			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2463	1	0	1	1	1	H2463_001_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	1	0	1	1	1	H2463_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	1	0	1	1	1	H2463_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	1	0	1	1	1	H2463_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	1	0	1	1	1	H2463_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	2	0	1	1	1	H2463_002_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	2	0	1	1	1	H2463_002_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	2	0	1	1	1	H2463_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	2	0	1	1	1	H2463_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2463	2	0	1	1	1	H2463_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2486	3	0	1	1	1	H2486_003_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2486	3	0	1	1	1	H2486_003_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2486	3	0	1	1	1	H2486_003_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2486	3	0	1	1	1	H2486_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2486	3	0	1	1	1	H2486_003_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	4	0	1	1	1	H2491_004_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	4	0	1	1	1	H2491_004_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	4	0	1	1	1	H2491_004_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	4	0	1	1	1	H2491_004_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.13	41		41																								41		41				41		41			41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	4	0	1	1	1	H2491_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	6	0	1	1	1	H2491_006_0	7	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	6	0	1	1	1	H2491_006_0	7	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	16		48																									16		48				16		0				16				16		0.53				0.53	0.53	0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	6	0	1	1	1	H2491_006_0	7	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	6	0	1	1	1	H2491_006_0	7	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				94.59	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	6	0	1	1	1	H2491_006_0	7	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	7	0	1	1	1	H2491_007_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	7	0	1	1	1	H2491_007_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H2491	7	0	1	1	1	H2491_007_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	7	0	1	1	1	H2491_007_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	7	0	1	1	1	H2491_007_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				79.41	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	7	0	1	1	1	H2491_007_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	8	0	1	1	1	H2491_008_0	7	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	8	0	1	1	1	H2491_008_0	7	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	11		33																									11		33				11		0				11				11		0.37				0.37	0.37	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	8	0	1	1	1	H2491_008_0	7	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	8	0	1	1	1	H2491_008_0	7	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				91.61	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	8	0	1	1	1	H2491_008_0	7	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	9	0	1	1	1	H2491_009_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	9	0	1	1	1	H2491_009_0	6	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	9	0	1	1	1	H2491_009_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	9	0	1	1	1	H2491_009_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				82.57	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	9	0	1	1	1	H2491_009_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					28																										28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	10	0	1	1	1	H2491_010_0	6	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	10	0	1	1	1	H2491_010_0	6	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	10	0	1	1	1	H2491_010_0	6	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	10	0	1	1	1	H2491_010_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	10	0	1	1	1	H2491_010_0	6	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	11	0	1	1	1	H2491_011_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	11	0	1	1	1	H2491_011_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	11	0	1	1	1	H2491_011_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	11	0	1	1	1	H2491_011_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				94.6	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	11	0	1	1	1	H2491_011_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	12	0	1	1	1	H2491_012_0	6	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	12	0	1	1	1	H2491_012_0	6	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	12	0	1	1	1	H2491_012_0	6	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	12	0	1	1	1	H2491_012_0	6	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				94.6	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	12	0	1	1	1	H2491_012_0	6	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	13	0	1	1	1	H2491_013_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	13	0	1	1	1	H2491_013_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	13	0	1	1	1	H2491_013_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	13	0	1	1	1	H2491_013_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.15	41		41																								41		41				41		41			41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	13	0	1	1	1	H2491_013_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	14	0	1	1	1	H2491_014_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	14	0	1	1	1	H2491_014_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H2491	14	0	1	1	1	H2491_014_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	14	0	1	1	1	H2491_014_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	14	0	1	1	1	H2491_014_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				79.1	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2491	14	0	1	1	1	H2491_014_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2506	1	0	1	48	5	H2506_001_0	3	Generic Drugs	4	11			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	0	0	0	0	0	0	0			
H2506	1	0	1	48	5	H2506_001_0	3	Brand Drugs	4	11			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	0	0	0	0	0	0	0			
H2506	1	0	1	48	5	H2506_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0			0	0			
H2531	1	0	1	48	5	H2531_001_0	5	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6	0	3.6	0	3.6	0	3.6			
H2531	1	0	1	48	5	H2531_001_0	5	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95	0	8.95	0	8.95	0	8.95			
H2531	1	0	1	48	5	H2531_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H2533	1	0	1	48	5	H2533_001_0	4	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H2533	1	0	1	48	5	H2533_001_0	4	Brand Drugs	4	11			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H2533	1	0	1	48	5	H2533_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	10		1	10		1	31								31						31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H2563	3	0	1	1	1	H2563_003_0	11	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	3	0	1	1	1	H2563_003_0	11	Generic	4	1	3	2	2	1	110		1	100		1	30		90				1	2			90				30		31	12		36																					0																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	3	0	1	1	1	H2563_003_0	11	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	3	0	1	1	1	H2563_003_0	11	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		285																					237.5																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	3	0	1	1	1	H2563_003_0	11	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31				554.32	27		27																				27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	1	1	1	1	H2563_005_1	11	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	1	1	1	1	H2563_005_1	11	Generic	4	1	3	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		24																					0																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	1	1	1	1	H2563_005_1	11	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	1	1	1	1	H2563_005_1	11	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	1	1	1	1	H2563_005_1	11	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31				603.3	28		28																				28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	2	1	1	1	H2563_005_2	11	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	2	1	1	1	H2563_005_2	11	Generic	4	1	3	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		24																					0																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	2	1	1	1	H2563_005_2	11	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	2	1	1	1	H2563_005_2	11	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	5	2	1	1	1	H2563_005_2	11	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31				603.3	28		28																				28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	8	0	1	1	1	H2563_008_0	9	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	8	0	1	1	1	H2563_008_0	9	Generic	4	1	3	2	2	1	110		1	100		1	30		90				1	2			90				30		31	12		36																					0																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	8	0	1	1	1	H2563_008_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	8	0	1	1	1	H2563_008_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		285																					237.5																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	8	0	1	1	1	H2563_008_0	9	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31				715.64	27		27																				27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	9	0	1	1	1	H2563_009_0	9	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	9	0	1	1	1	H2563_009_0	9	Generic	4	1	3	2	2	1	110		1	100		1	30		90				1	2			90				30		31	12		36																					0																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	9	0	1	1	1	H2563_009_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	9	0	1	1	1	H2563_009_0	9	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		285																					237.5																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	9	0	1	1	1	H2563_009_0	9	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31				669.02	27		27																				27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	12	0	1	1	1	H2563_012_0	8	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	12	0	1	1	1	H2563_012_0	8	Generic	4	1	3	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		24																					0																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	12	0	1	1	1	H2563_012_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	12	0	1	1	1	H2563_012_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	12	0	1	1	1	H2563_012_0	8	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31				629.38	28		28																				28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	13	0	1	1	1	H2563_013_0	8	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	13	0	1	1	1	H2563_013_0	8	Generic	4	1	3	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		24																					0																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	13	0	1	1	1	H2563_013_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					112.5																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	13	0	1	1	1	H2563_013_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2563	13	0	1	1	1	H2563_013_0	8	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31				589.08	28		28																				28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	1	1	4	1	H2577_001_1	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	1	1	4	1	H2577_001_1	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	1	1	4	1	H2577_001_1	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	1	1	4	1	H2577_001_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	1	1	4	1	H2577_001_1	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											822	29		29				621	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	2	1	4	1	H2577_001_2	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	2	1	4	1	H2577_001_2	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	2	1	4	1	H2577_001_2	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	2	1	4	1	H2577_001_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	1	2	1	4	1	H2577_001_2	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											822	29		29				621	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	2	0	1	4	1	H2577_002_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	2	0	1	4	1	H2577_002_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	2	0	1	4	1	H2577_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	2	0	1	4	1	H2577_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	2	0	1	4	1	H2577_002_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1000	29		29				840	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	1	1	4	1	H2577_003_1	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	1	1	4	1	H2577_003_1	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	1	1	4	1	H2577_003_1	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	1	1	4	1	H2577_003_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	1	1	4	1	H2577_003_1	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											708	25		25				535	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	2	1	4	1	H2577_003_2	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	2	1	4	1	H2577_003_2	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	2	1	4	1	H2577_003_2	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	2	1	4	1	H2577_003_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	3	2	1	4	1	H2577_003_2	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											708	25		25				535	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	4	0	1	4	1	H2577_004_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	4	0	1	4	1	H2577_004_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	4	0	1	4	1	H2577_004_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	4	0	1	4	1	H2577_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	4	0	1	4	1	H2577_004_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				946	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	5	0	1	4	1	H2577_005_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	5	0	1	4	1	H2577_005_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	5	0	1	4	1	H2577_005_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	5	0	1	4	1	H2577_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	5	0	1	4	1	H2577_005_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											949	31		31				804	31		31												31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	6	0	1	4	1	H2577_006_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	6	0	1	4	1	H2577_006_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	6	0	1	4	1	H2577_006_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	6	0	1	4	1	H2577_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	6	0	1	4	1	H2577_006_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				920	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	7	0	1	4	1	H2577_007_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	7	0	1	4	1	H2577_007_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		10													45						10				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	7	0	1	4	1	H2577_007_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	7	0	1	4	1	H2577_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	7	0	1	4	1	H2577_007_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											899	33		33				724	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	8	0	1	4	1	H2577_008_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	8	0	1	4	1	H2577_008_0	5	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		10													45						10				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	8	0	1	4	1	H2577_008_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	8	0	1	4	1	H2577_008_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	8	0	1	4	1	H2577_008_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											899	33		33				724	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	9	0	1	4	1	H2577_009_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	9	0	1	4	1	H2577_009_0	2	Generic	4	1	3	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	9	0	1	4	1	H2577_009_0	2	Generic	4	1	3	2	2	3		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H2577	9	0	1	4	1	H2577_009_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	9	0	1	4	1	H2577_009_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2577	9	0	1	4	1	H2577_009_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											861	29		29				685	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2593	1	0	1	1	1	H2593_001_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	1	0	1	1	1	H2593_001_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	1	0	1	1	1	H2593_001_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	1	0	1	1	1	H2593_001_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	1	0	1	1	1	H2593_001_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	1	0	1	1	1	H2593_001_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	1	0	1	1	1	H2593_001_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	1	0	1	1	1	H2593_001_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	1	0	1	1	1	H2593_001_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	3	0	1	1	1	H2593_003_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	3	0	1	1	1	H2593_003_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	3	0	1	1	1	H2593_003_0	9	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	3	0	1	1	1	H2593_003_0	9	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	3	0	1	1	1	H2593_003_0	9	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	3	0	1	1	1	H2593_003_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	3	0	1	1	1	H2593_003_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	3	0	1	1	1	H2593_003_0	9	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	3	0	1	1	1	H2593_003_0	9	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	5	0	1	1	1	H2593_005_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	5	0	1	1	1	H2593_005_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	5	0	1	1	1	H2593_005_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	5	0	1	1	1	H2593_005_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	5	0	1	1	1	H2593_005_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	5	0	1	1	1	H2593_005_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	5	0	1	1	1	H2593_005_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	5	0	1	1	1	H2593_005_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	5	0	1	1	1	H2593_005_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	6	0	1	1	1	H2593_006_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	6	0	1	1	1	H2593_006_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	6	0	1	1	1	H2593_006_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	6	0	1	1	1	H2593_006_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	6	0	1	1	1	H2593_006_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	6	0	1	1	1	H2593_006_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	6	0	1	1	1	H2593_006_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	6	0	1	1	1	H2593_006_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	6	0	1	1	1	H2593_006_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	13	0	1	1	1	H2593_013_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	13	0	1	1	1	H2593_013_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	13	0	1	1	1	H2593_013_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	13	0	1	1	1	H2593_013_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	13	0	1	1	1	H2593_013_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	13	0	1	1	1	H2593_013_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	13	0	1	1	1	H2593_013_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	13	0	1	1	1	H2593_013_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	13	0	1	1	1	H2593_013_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	18	0	1	1	1	H2593_018_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	18	0	1	1	1	H2593_018_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15.5	31	46.5					10.5	21	31.5					10.5	21	21																15.5				15.5			0.52	0.35	0.35			0.46	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	18	0	1	1	1	H2593_018_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	18	0	1	1	1	H2593_018_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					90	180	270					90	180	180																95				95			3.17	3	3			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	18	0	1	1	1	H2593_018_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	18	0	1	1	1	H2593_018_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					10	20	30					10	20	20																10				10			0.33	0.33	0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	19	0	1	1	1	H2593_019_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	19	0	1	1	1	H2593_019_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	19	0	1	1	1	H2593_019_0	9	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	19	0	1	1	1	H2593_019_0	9	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	19	0	1	1	1	H2593_019_0	9	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	19	0	1	1	1	H2593_019_0	9	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	19	0	1	1	1	H2593_019_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	19	0	1	1	1	H2593_019_0	9	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	19	0	1	1	1	H2593_019_0	9	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	20	0	1	1	1	H2593_020_0	11	Preferred Generic	4	1	1	1	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34				1.3	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	20	0	1	1	1	H2593_020_0	11	Generic	4	1	1	1	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				4.8	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	20	0	1	1	1	H2593_020_0	11	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				61.14	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	20	0	1	1	1	H2593_020_0	11	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				47.44	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	20	0	1	1	1	H2593_020_0	11	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	20	0	1	1	1	H2593_020_0	11	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	20	0	1	1	1	H2593_020_0	11	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	21	0	1	1	1	H2593_021_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	21	0	1	1	1	H2593_021_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	21	0	1	1	1	H2593_021_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	21	0	1	1	1	H2593_021_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	21	0	1	1	1	H2593_021_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	21	0	1	1	1	H2593_021_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	21	0	1	1	1	H2593_021_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	21	0	1	1	1	H2593_021_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	21	0	1	1	1	H2593_021_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	22	0	1	1	1	H2593_022_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					0	0	0																7				7			0.23	0.07	0			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	22	0	1	1	1	H2593_022_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	16	16																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	22	0	1	1	1	H2593_022_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	22	0	1	1	1	H2593_022_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	22	0	1	1	1	H2593_022_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	22	0	1	1	1	H2593_022_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	22	0	1	1	1	H2593_022_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	23	0	1	1	1	H2593_023_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					0	0	0																7				7			0.23	0.07	0			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	23	0	1	1	1	H2593_023_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	16	16																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	23	0	1	1	1	H2593_023_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	23	0	1	1	1	H2593_023_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	23	0	1	1	1	H2593_023_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	23	0	1	1	1	H2593_023_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	23	0	1	1	1	H2593_023_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	24	0	1	1	1	H2593_024_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	24	0	1	1	1	H2593_024_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	24	0	1	1	1	H2593_024_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	24	0	1	1	1	H2593_024_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	24	0	1	1	1	H2593_024_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	24	0	1	1	1	H2593_024_0	10	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	24	0	1	1	1	H2593_024_0	10	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	25	0	1	1	1	H2593_025_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	25	0	1	1	1	H2593_025_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	25	0	1	1	1	H2593_025_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					9	18	27					9	27	27																9				9			0.3	0.3	0.3			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	25	0	1	1	1	H2593_025_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	25	0	1	1	1	H2593_025_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	25	0	1	1	1	H2593_025_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	25	0	1	1	1	H2593_025_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	25	0	1	1	1	H2593_025_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	26	0	1	1	1	H2593_026_0	12	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	26	0	1	1	1	H2593_026_0	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	26	0	1	1	1	H2593_026_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	26	0	1	1	1	H2593_026_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	26	0	1	1	1	H2593_026_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	26	0	1	1	1	H2593_026_0	12	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	26	0	1	1	1	H2593_026_0	12	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	27	0	1	1	1	H2593_027_0	12	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	27	0	1	1	1	H2593_027_0	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	27	0	1	1	1	H2593_027_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	27	0	1	1	1	H2593_027_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	27	0	1	1	1	H2593_027_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	27	0	1	1	1	H2593_027_0	12	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	27	0	1	1	1	H2593_027_0	12	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	28	1	1	1	1	H2593_028_1	14	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	1	1	1	1	H2593_028_1	14	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	1	1	1	1	H2593_028_1	14	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	1	1	1	1	H2593_028_1	14	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	1	1	1	1	H2593_028_1	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	1	1	1	1	H2593_028_1	14	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	1	1	1	1	H2593_028_1	14	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	28	2	1	1	1	H2593_028_2	14	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	2	1	1	1	H2593_028_2	14	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	2	1	1	1	H2593_028_2	14	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	2	1	1	1	H2593_028_2	14	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	2	1	1	1	H2593_028_2	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	2	1	1	1	H2593_028_2	14	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	2	1	1	1	H2593_028_2	14	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	28	3	1	1	1	H2593_028_3	13	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	3	1	1	1	H2593_028_3	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	3	1	1	1	H2593_028_3	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	3	1	1	1	H2593_028_3	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	3	1	1	1	H2593_028_3	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	3	1	1	1	H2593_028_3	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	3	1	1	1	H2593_028_3	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	28	4	1	1	1	H2593_028_4	13	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	4	1	1	1	H2593_028_4	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	4	1	1	1	H2593_028_4	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	4	1	1	1	H2593_028_4	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	4	1	1	1	H2593_028_4	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	4	1	1	1	H2593_028_4	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	4	1	1	1	H2593_028_4	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	28	5	1	1	1	H2593_028_5	13	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	5	1	1	1	H2593_028_5	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	5	1	1	1	H2593_028_5	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	5	1	1	1	H2593_028_5	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	5	1	1	1	H2593_028_5	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	5	1	1	1	H2593_028_5	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	5	1	1	1	H2593_028_5	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	28	6	1	1	1	H2593_028_6	14	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	6	1	1	1	H2593_028_6	14	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	6	1	1	1	H2593_028_6	14	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	6	1	1	1	H2593_028_6	14	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	6	1	1	1	H2593_028_6	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	6	1	1	1	H2593_028_6	14	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	28	6	1	1	1	H2593_028_6	14	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	29	0	1	1	1	H2593_029_0	12	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	29	0	1	1	1	H2593_029_0	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	29	0	1	1	1	H2593_029_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	29	0	1	1	1	H2593_029_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	29	0	1	1	1	H2593_029_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	29	0	1	1	1	H2593_029_0	12	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	29	0	1	1	1	H2593_029_0	12	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	30	1	1	1	1	H2593_030_1	13	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	1	1	1	1	H2593_030_1	13	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H2593	30	1	1	1	1	H2593_030_1	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	1	1	1	1	H2593_030_1	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	1	1	1	1	H2593_030_1	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	1	1	1	1	H2593_030_1	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	1	1	1	1	H2593_030_1	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	1	1	1	1	H2593_030_1	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	30	2	1	1	1	H2593_030_2	13	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	2	1	1	1	H2593_030_2	13	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H2593	30	2	1	1	1	H2593_030_2	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	2	1	1	1	H2593_030_2	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	2	1	1	1	H2593_030_2	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	2	1	1	1	H2593_030_2	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	2	1	1	1	H2593_030_2	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	2	1	1	1	H2593_030_2	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	30	3	1	1	1	H2593_030_3	13	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	3	1	1	1	H2593_030_3	13	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H2593	30	3	1	1	1	H2593_030_3	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	3	1	1	1	H2593_030_3	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	3	1	1	1	H2593_030_3	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	3	1	1	1	H2593_030_3	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	3	1	1	1	H2593_030_3	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	3	1	1	1	H2593_030_3	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	30	4	1	1	1	H2593_030_4	13	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	4	1	1	1	H2593_030_4	13	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H2593	30	4	1	1	1	H2593_030_4	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	4	1	1	1	H2593_030_4	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	4	1	1	1	H2593_030_4	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	4	1	1	1	H2593_030_4	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	4	1	1	1	H2593_030_4	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	4	1	1	1	H2593_030_4	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	30	5	1	1	1	H2593_030_5	13	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	5	1	1	1	H2593_030_5	13	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H2593	30	5	1	1	1	H2593_030_5	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	5	1	1	1	H2593_030_5	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	5	1	1	1	H2593_030_5	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	5	1	1	1	H2593_030_5	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	5	1	1	1	H2593_030_5	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	5	1	1	1	H2593_030_5	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	30	6	1	1	1	H2593_030_6	13	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	6	1	1	1	H2593_030_6	13	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H2593	30	6	1	1	1	H2593_030_6	13	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	6	1	1	1	H2593_030_6	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	6	1	1	1	H2593_030_6	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	6	1	1	1	H2593_030_6	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	6	1	1	1	H2593_030_6	13	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	30	6	1	1	1	H2593_030_6	13	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	31	0	1	2	1	H2593_031_0	15	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					2	6	6																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	31	0	1	2	1	H2593_031_0	15	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					7	14	21					7	21	21																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	31	0	1	2	1	H2593_031_0	15	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	31	0	1	2	1	H2593_031_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								98	196	294					93	186	279					93	279	279																98				98			3.27	3.1	3.1			2.88	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	31	0	1	2	1	H2593_031_0	15	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	31	0	1	2	1	H2593_031_0	15	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	31	0	1	2	1	H2593_031_0	15	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	32	0	1	1	1	H2593_032_0	12	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	32	0	1	1	1	H2593_032_0	12	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H2593	32	0	1	1	1	H2593_032_0	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	32	0	1	1	1	H2593_032_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	32	0	1	1	1	H2593_032_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	32	0	1	1	1	H2593_032_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	32	0	1	1	1	H2593_032_0	12	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	32	0	1	1	1	H2593_032_0	12	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	33	0	1	1	1	H2593_033_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	33	0	1	1	1	H2593_033_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	33	0	1	1	1	H2593_033_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					14	28	42					14	42	42																14				14			0.47	0.47	0.47			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	33	0	1	1	1	H2593_033_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	33	0	1	1	1	H2593_033_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	33	0	1	1	1	H2593_033_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	33	0	1	1	1	H2593_033_0	10	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	33	0	1	1	1	H2593_033_0	10	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	34	0	1	1	1	H2593_034_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	34	0	1	1	1	H2593_034_0	11	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	34	0	1	1	1	H2593_034_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	34	0	1	1	1	H2593_034_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	34	0	1	1	1	H2593_034_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	34	0	1	1	1	H2593_034_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	34	0	1	1	1	H2593_034_0	11	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	34	0	1	1	1	H2593_034_0	11	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	35	0	1	1	1	H2593_035_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	35	0	1	1	1	H2593_035_0	11	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	35	0	1	1	1	H2593_035_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					12	24	36					12	36	36																12				12			0.4	0.4	0.4			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	35	0	1	1	1	H2593_035_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	35	0	1	1	1	H2593_035_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	35	0	1	1	1	H2593_035_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	35	0	1	1	1	H2593_035_0	11	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	35	0	1	1	1	H2593_035_0	11	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	36	0	1	1	1	H2593_036_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	36	0	1	1	1	H2593_036_0	11	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	36	0	1	1	1	H2593_036_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					13	26	39					13	39	39																13				13			0.43	0.43	0.43			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	36	0	1	1	1	H2593_036_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	36	0	1	1	1	H2593_036_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	36	0	1	1	1	H2593_036_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	36	0	1	1	1	H2593_036_0	11	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	36	0	1	1	1	H2593_036_0	11	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	37	0	1	1	1	H2593_037_0	14	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	37	0	1	1	1	H2593_037_0	14	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	37	0	1	1	1	H2593_037_0	14	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	37	0	1	1	1	H2593_037_0	14	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	37	0	1	1	1	H2593_037_0	14	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	37	0	1	1	1	H2593_037_0	14	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	37	0	1	1	1	H2593_037_0	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	37	0	1	1	1	H2593_037_0	14	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	37	0	1	1	1	H2593_037_0	14	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	38	0	1	1	1	H2593_038_0	14	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	38	0	1	1	1	H2593_038_0	14	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	38	0	1	1	1	H2593_038_0	14	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	38	0	1	1	1	H2593_038_0	14	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	38	0	1	1	1	H2593_038_0	14	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	38	0	1	1	1	H2593_038_0	14	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	38	0	1	1	1	H2593_038_0	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	38	0	1	1	1	H2593_038_0	14	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	38	0	1	1	1	H2593_038_0	14	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	39	0	1	1	1	H2593_039_0	14	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	39	0	1	1	1	H2593_039_0	14	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	39	0	1	1	1	H2593_039_0	14	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	39	0	1	1	1	H2593_039_0	14	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	39	0	1	1	1	H2593_039_0	14	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	39	0	1	1	1	H2593_039_0	14	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	39	0	1	1	1	H2593_039_0	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	39	0	1	1	1	H2593_039_0	14	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	39	0	1	1	1	H2593_039_0	14	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	40	0	1	1	1	H2593_040_0	12	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	40	0	1	1	1	H2593_040_0	12	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	40	0	1	1	1	H2593_040_0	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	40	0	1	1	1	H2593_040_0	12	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	40	0	1	1	1	H2593_040_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	40	0	1	1	1	H2593_040_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	40	0	1	1	1	H2593_040_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	40	0	1	1	1	H2593_040_0	12	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	40	0	1	1	1	H2593_040_0	12	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	41	0	1	1	1	H2593_041_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	41	0	1	1	1	H2593_041_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	41	0	1	1	1	H2593_041_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	41	0	1	1	1	H2593_041_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	41	0	1	1	1	H2593_041_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	41	0	1	1	1	H2593_041_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	41	0	1	1	1	H2593_041_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	41	0	1	1	1	H2593_041_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	41	0	1	1	1	H2593_041_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2593	42	0	1	1	1	H2593_042_0	12	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	42	0	1	1	1	H2593_042_0	12	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	42	0	1	1	1	H2593_042_0	12	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	42	0	1	1	1	H2593_042_0	12	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2593	42	0	1	1	1	H2593_042_0	12	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	42	0	1	1	1	H2593_042_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	42	0	1	1	1	H2593_042_0	12	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	42	0	1	1	1	H2593_042_0	12	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2593	42	0	1	1	1	H2593_042_0	12	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H2610	5	0	1	1	1	H2610_005_0	5	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								4	8	12					0	0	0							12																4				4			0.13	0				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	5	0	1	1	1	H2610_005_0	5	Generic	4	1	3	2	2	1		111	1	100		1				30	60	90	1	2			90				30		31								12	24	36					0	0	0							36																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	5	0	1	1	1	H2610_005_0	5	Preferred Brand	4	10	1	2	3	1		111	1	100		1				30	60	90	1	2			90				30		31								47	94	141					39	78	117							141																47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	5	0	1	1	1	H2610_005_0	5	Non-Preferred Brand	4	10	1	2	4	1		111	1	100		1				30	60	90	1	2			90				30		31								100	200	300					75	150	225							300																100				100			3.33	2.5				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	5	0	1	1	1	H2610_005_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											513.11	33						513.11	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	5	0	1	1	1	H2610_005_0	5	Select Diabetic Drugs	4	11	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								0	0	0					0	0	0							0																0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	6	0	1	1	1	H2610_006_0	5	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								4	8	12					0	0	0							12																4				4			0.13	0				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	6	0	1	1	1	H2610_006_0	5	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								4	8	12					0	0	0							12																4				4			0.13	0				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"										1		
H2610	6	0	1	1	1	H2610_006_0	5	Generic	4	1	3	2	2	1		111	1	100		1				30	60	90	1	2			90				30		31								12	24	36					0	0	0							36																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	6	0	1	1	1	H2610_006_0	5	Generic	4	1	3	2	2	3		111	1	100		1				30	60	90	1	2			90				30		31								12	24	36					0	0	0							36																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"										1		3
H2610	6	0	1	1	1	H2610_006_0	5	Preferred Brand	4	10	1	2	3	1		111	1	100		1				30	60	90	1	2			90				30		31								42	84	126					34	68	102							126																42				42			1.4	1.13				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	6	0	1	1	1	H2610_006_0	5	Non-Preferred Brand	4	10	1	2	4	1		111	1	100		1				30	60	90	1	2			90				30		31								80	160	240					65	130	195							240																80				80			2.67	2.17				2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	6	0	1	1	1	H2610_006_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											541	33						541	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	6	0	1	1	1	H2610_006_0	5	Select Diabetic Drugs	4	11	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								0	0	0					0	0	0							0																0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	6	0	1	1	1	H2610_006_0	5	Select Diabetic Drugs	4	11	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								0	0	0					0	0	0							0																0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"										1		
H2610	11	0	1	1	1	H2610_011_0	4	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								7	14	21					0	0	0							21																7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	11	0	1	1	1	H2610_011_0	4	Generic	4	1	3	2	2	1		111	1	100		1				30	60	90	1	2			90				30		31								12	24	36					0	0	0							36																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	11	0	1	1	1	H2610_011_0	4	Preferred Brand	4	10	1	2	3	1		111	1	100		1				30	60	90	1	2			90				30		31								47	94	141					42	84	126							141																47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	11	0	1	1	1	H2610_011_0	4	Non-Preferred Brand	4	10	1	2	4	1		111	1	100		1				30	60	90	1	2			90				30		31								95	190	285					85	170	255							285																95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	11	0	1	1	1	H2610_011_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											450.22	33						450.22	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	11	0	1	1	1	H2610_011_0	4	Select Diabetic Drugs	4	11	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								0	0	0					0	0	0							0																0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	15	0	1	1	1	H2610_015_0	4	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	15	0	1	1	1	H2610_015_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	6	12	18																					0																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	15	0	1	1	1	H2610_015_0	4	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	15	0	1	1	1	H2610_015_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	15	0	1	1	1	H2610_015_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				439.64	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	15	0	1	1	1	H2610_015_0	4	Select Diabetic Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	16	0	1	1	1	H2610_016_0	3	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								4	8	12					0	0	0							12																4				4			0.13	0				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	16	0	1	1	1	H2610_016_0	3	Generic	4	1	3	2	2	1		111	1	100		1				30	60	90	1	2			90				30		31								12	24	36					0	0	0							36																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	16	0	1	1	1	H2610_016_0	3	Preferred Brand	4	10	1	2	3	1		111	1	100		1				30	60	90	1	2			90				30		31								47	94	141					39	78	117							141																47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	16	0	1	1	1	H2610_016_0	3	Non-Preferred Brand	4	10	1	2	4	1		111	1	100		1				30	60	90	1	2			90				30		31								100	200	300					75	150	225							300																100				100			3.33	2.5				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	16	0	1	1	1	H2610_016_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											513.11	33						513.11	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2610	16	0	1	1	1	H2610_016_0	3	Select Diabetic Drugs	4	11	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								0	0	0					0	0	0							0																0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs"												
H2624	1	0	1	1	1	H2624_001_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2624	1	0	1	1	1	H2624_001_0	7	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2624	1	0	1	1	1	H2624_001_0	7	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15	30	30																			15	30	30																	15			15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2624	1	0	1	1	1	H2624_001_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45	90	90																			45	90	90																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2624	1	0	1	1	1	H2624_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90	180	180																			90	180	180																	90			90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2624	1	0	1	1	1	H2624_001_0	7	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				884.38	33	33	33																		33	33	33																33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2624	1	0	1	1	1	H2624_001_0	7	Select Care Drugs	4	11	1	2	6	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2624	1	0	1	1	1	H2624_001_0	7	Select Care Drugs	4	11	1	2	6	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	2	
H2663	2	0	1	1	1	H2663_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	2	0	1	1	1	H2663_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	2	0	1	1	1	H2663_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	2	0	1	1	1	H2663_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	2	0	1	1	1	H2663_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	2	0	1	1	1	H2663_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	2	0	1	1	1	H2663_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											928.73	33						945.55	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	5	0	1	1	1	H2663_005_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	5	0	1	1	1	H2663_005_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	5	0	1	1	1	H2663_005_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	5	0	1	1	1	H2663_005_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	5	0	1	1	1	H2663_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	5	0	1	1	1	H2663_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	5	0	1	1	1	H2663_005_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											837.81	33						804.2	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	6	0	1	2	1	H2663_006_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	6	0	1	2	1	H2663_006_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	6	0	1	2	1	H2663_006_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	6	0	1	2	1	H2663_006_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	6	0	1	2	1	H2663_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	6	0	1	2	1	H2663_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	6	0	1	2	1	H2663_006_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											826.99	33						726.36	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	15	0	1	2	1	H2663_015_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	15	0	1	2	1	H2663_015_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	15	0	1	2	1	H2663_015_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	15	0	1	2	1	H2663_015_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	15	0	1	2	1	H2663_015_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	15	0	1	2	1	H2663_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	15	0	1	2	1	H2663_015_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											721.3	33						746.08	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	17	0	1	1	1	H2663_017_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	17	0	1	1	1	H2663_017_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	17	0	1	1	1	H2663_017_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	17	0	1	1	1	H2663_017_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	17	0	1	1	1	H2663_017_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	17	0	1	1	1	H2663_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	17	0	1	1	1	H2663_017_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											764.9	33						733.13	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	21	0	1	1	1	H2663_021_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	21	0	1	1	1	H2663_021_0	3	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	21	0	1	1	1	H2663_021_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	21	0	1	1	1	H2663_021_0	3	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	21	0	1	1	1	H2663_021_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	21	0	1	1	1	H2663_021_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	21	0	1	1	1	H2663_021_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				750.99	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	23	0	1	2	1	H2663_023_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	23	0	1	2	1	H2663_023_0	3	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	23	0	1	2	1	H2663_023_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	23	0	1	2	1	H2663_023_0	3	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	23	0	1	2	1	H2663_023_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	23	0	1	2	1	H2663_023_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	23	0	1	2	1	H2663_023_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				689.25	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	26	0	1	1	1	H2663_026_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	26	0	1	1	1	H2663_026_0	4	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	26	0	1	1	1	H2663_026_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	26	0	1	1	1	H2663_026_0	4	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	26	0	1	1	1	H2663_026_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	26	0	1	1	1	H2663_026_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	26	0	1	1	1	H2663_026_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				693.69	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	28	0	1	1	1	H2663_028_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	28	0	1	1	1	H2663_028_0	3	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	28	0	1	1	1	H2663_028_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	28	0	1	1	1	H2663_028_0	3	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	28	0	1	1	1	H2663_028_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	28	0	1	1	1	H2663_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	28	0	1	1	1	H2663_028_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				570.77	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	29	0	1	1	1	H2663_029_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	29	0	1	1	1	H2663_029_0	3	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	29	0	1	1	1	H2663_029_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	29	0	1	1	1	H2663_029_0	3	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7	14	0																			7	14	0																	7			7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	29	0	1	1	1	H2663_029_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	29	0	1	1	1	H2663_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	29	0	1	1	1	H2663_029_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				768.97	33																				33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	32	0	1	1	1	H2663_032_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	32	0	1	1	1	H2663_032_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	32	0	1	1	1	H2663_032_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	32	0	1	1	1	H2663_032_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	32	0	1	1	1	H2663_032_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	32	0	1	1	1	H2663_032_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	32	0	1	1	1	H2663_032_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											832.63	33						775.93	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	34	0	1	1	1	H2663_034_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	34	0	1	1	1	H2663_034_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	34	0	1	1	1	H2663_034_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	34	0	1	1	1	H2663_034_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	34	0	1	1	1	H2663_034_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	34	0	1	1	1	H2663_034_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	34	0	1	1	1	H2663_034_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											637.85	28						599.89	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	35	0	1	1	1	H2663_035_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	35	0	1	1	1	H2663_035_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	35	0	1	1	1	H2663_035_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	35	0	1	1	1	H2663_035_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	35	0	1	1	1	H2663_035_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	35	0	1	1	1	H2663_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	35	0	1	1	1	H2663_035_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											748.8	33						707.67	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	36	0	1	1	1	H2663_036_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	36	0	1	1	1	H2663_036_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	36	0	1	1	1	H2663_036_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	36	0	1	1	1	H2663_036_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2663	36	0	1	1	1	H2663_036_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	36	0	1	1	1	H2663_036_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2663	36	0	1	1	1	H2663_036_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											748.72	33						707.61	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2722	1	0	1	2	1	H2722_001_0	11	Preferred Generic	2	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	1	0	1	2	1	H2722_001_0	11	Generic	2	1	1	2	2	1	110		1		110	1	31		90				1	2				31		90	31		31	9		27																									9		27				9		27				9				9		0.29				0.29	0.29	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	1	0	1	2	1	H2722_001_0	11	Preferred Brand	2	10	1	1	3	1	110		1		110	1	31		90				1	2				31		90	31		31				106.61	25		25																								25		25				25		25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	1	0	1	2	1	H2722_001_0	11	Non-Preferred Brand	2	10	1	1	4	1	110		1		110	1	31		90				1	2				31		90	31		31				124.58	25		25																								25		25				25		25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	1	0	1	2	1	H2722_001_0	11	Specialty Tier	2	10	1	1	5	1	10		1		10	1	31											31			31		31				1028.83	25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	2	0	1	2	1	H2722_002_0	12	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	6		18																									6		18				0		0				6				6		0.19				0.19	0	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	2	0	1	2	1	H2722_002_0	12	Generic	4	1	1	2	2	1	110		1		110	1	31		90				1	2				31		90	31		31	15		45																									15		45				15		45				15				15		0.48				0.48	0.48	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	2	0	1	2	1	H2722_002_0	12	Preferred Brand	4	10	1	2	3	1	110		1		110	1	31		90				1	2				31		90	31		31	47		141																									47		141				47		141				47				47		1.52				1.52	1.52	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	2	0	1	2	1	H2722_002_0	12	Non-Preferred Brand	4	10	1	2	4	1	110		1		110	1	31		90				1	2				31		90	31		31	100		300																									100		300				100		300				100				100		3.23				3.23	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2722	2	0	1	2	1	H2722_002_0	12	Specialty Tier	4	10	1	1	5	1	10		1		10	1	31											31			31		31				1194.52	25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H2773	3	0	1	1	1	H2773_003_0	5	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	3	0	1	1	1	H2773_003_0	5	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	4		12																			4		8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2773	3	0	1	1	1	H2773_003_0	5	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		20																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	3	0	1	1	1	H2773_003_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	30		90																			30		90																30				30		0.97			0.97			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	3	0	1	1	1	H2773_003_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		1	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 Drug, Specialty Tier"												
H2773	3	0	1	1	1	H2773_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31					30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	17	0	1	1	1	H2773_017_0	8	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	17	0	1	1	1	H2773_017_0	8	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2773	17	0	1	1	1	H2773_017_0	8	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		20																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	17	0	1	1	1	H2773_017_0	8	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	35		105																			35		105																35				35		1.13			1.13			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	17	0	1	1	1	H2773_017_0	8	Non-Preferred Drug	4	11	3	1	4	1	110		1	110		1	31		90				1	2	31		90				31		31				37.2	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	17	0	1	1	1	H2773_017_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	18	0	1	1	1	H2773_018_0	5	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	18	0	1	1	1	H2773_018_0	5	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2773	18	0	1	1	1	H2773_018_0	5	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	20		60																			20		40																20				20		0.65			0.65			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	18	0	1	1	1	H2773_018_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	18	0	1	1	1	H2773_018_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		1	110		1	31		90				1	2	31		90				31		31				43.62	40		40																		40		40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	18	0	1	1	1	H2773_018_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	19	0	1	1	1	H2773_019_0	5	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	19	0	1	1	1	H2773_019_0	5	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	4		12																			4		8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2773	19	0	1	1	1	H2773_019_0	5	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	15		45																			15		30																15				15		0.48			0.48			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	19	0	1	1	1	H2773_019_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	35		105																			35		105																35				35		1.13			1.13			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	19	0	1	1	1	H2773_019_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		1	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 Drug, Specialty Tier"												
H2773	19	0	1	1	1	H2773_019_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	20	0	1	1	1	H2773_020_0	5	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	20	0	1	1	1	H2773_020_0	5	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	4		12																			4		8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2773	20	0	1	1	1	H2773_020_0	5	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		20																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	20	0	1	1	1	H2773_020_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	35		105																			35		105																35				35		1.13			1.13			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	20	0	1	1	1	H2773_020_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		1	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 Drug, Specialty Tier"												
H2773	20	0	1	1	1	H2773_020_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	23	0	1	1	1	H2773_023_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	23	0	1	1	1	H2773_023_0	6	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2773	23	0	1	1	1	H2773_023_0	6	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		20																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	23	0	1	1	1	H2773_023_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	25		75																			25		75																25				25		0.81			0.81			0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2773	23	0	1	1	1	H2773_023_0	6	Non-Preferred Drug	4	11	3	1	4	1	110		1	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 Drug, Specialty Tier"												
H2773	23	0	1	1	1	H2773_023_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	100	0	1	4	1	H2775_100_0	7	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								7		17.5					2		5											7		17.5				2		0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	100	0	1	4	1	H2775_100_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		30					7		17.5											12		30				7		0				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	100	0	1	4	1	H2775_100_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		117.5					37		92.5											47		117.5				37		74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	100	0	1	4	1	H2775_100_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								100		250					90		225											100		250				90		180				100				100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	100	0	1	4	1	H2775_100_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	105	0	1	4	1	H2775_105_0	8	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		12.5					0		0											5		12.5				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	105	0	1	4	1	H2775_105_0	8	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								10		25					5		12.5											10		25				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	105	0	1	4	1	H2775_105_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		112.5					35		87.5											45		112.5				35		70				45				45			1.5	1.17		1.5	1.17	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	105	0	1	4	1	H2775_105_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								85		212.5					75		187.5											85		212.5				75		150				85				85			2.83	2.5		2.83	2.5	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	105	0	1	4	1	H2775_105_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	106	0	1	4	1	H2775_106_0	9	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								7		17.5					2		5											7		17.5				2		0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	106	0	1	4	1	H2775_106_0	9	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		30					7		17.5											12		30				7		0				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	106	0	1	4	1	H2775_106_0	9	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		117.5					37		92.5											47		117.5				37		74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	106	0	1	4	1	H2775_106_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								100		250					90		225											100		250				90		180				100				100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	106	0	1	4	1	H2775_106_0	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	107	0	1	4	1	H2775_107_0	8	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								7		17.5					2		5											7		17.5				2		0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	107	0	1	4	1	H2775_107_0	8	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		30					7		17.5											12		30				7		0				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	107	0	1	4	1	H2775_107_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		117.5					37		92.5											47		117.5				37		74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	107	0	1	4	1	H2775_107_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								100		250					90		225											100		250				90		180				100				100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	107	0	1	4	1	H2775_107_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	109	0	1	4	1	H2775_109_0	8	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								7		17.5					2		5											7		17.5				2		0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	109	0	1	4	1	H2775_109_0	8	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		30					7		17.5											12		30				7		0				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	109	0	1	4	1	H2775_109_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		117.5					37		92.5											47		117.5				37		74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	109	0	1	4	1	H2775_109_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								100		250					90		225											100		250				90		180				100				100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2775	109	0	1	4	1	H2775_109_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	3	0	1	1	1	H2793_003_0	4	Preferred Generic	4	11	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	3	0	1	1	1	H2793_003_0	4	Preferred Generic	4	11	1	1	1	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2793	3	0	1	1	1	H2793_003_0	4	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	5		12																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	3	0	1	1	1	H2793_003_0	4	Generic	4	11	1	1	2	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2793	3	0	1	1	1	H2793_003_0	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		110																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	3	0	1	1	1	H2793_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		225																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	3	0	1	1	1	H2793_003_0	4	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1142.2	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	4	0	1	1	1	H2793_004_0	4	Preferred Generic	4	11	1	1	1	1	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	4	0	1	1	1	H2793_004_0	4	Preferred Generic	4	11	1	1	1	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2793	4	0	1	1	1	H2793_004_0	4	Generic	4	11	1	1	2	1	110		1	100		1	30		90				1	2			90				30		31				8.29	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	4	0	1	1	1	H2793_004_0	4	Generic	4	11	1	1	2	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2793	4	0	1	1	1	H2793_004_0	4	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		31				93.95	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	4	0	1	1	1	H2793_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		31				37.56	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	4	0	1	1	1	H2793_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				614.61	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2793	5	0	1	1	1	H2793_005_0	4	Preferred Generic	4	11	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2793	5	0	1	1	1	H2793_005_0	4	Preferred Generic	4	11	1	1	1	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2793	5	0	1	1	1	H2793_005_0	4	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	5		12																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2793	5	0	1	1	1	H2793_005_0	4	Generic	4	11	1	1	2	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2793	5	0	1	1	1	H2793_005_0	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		110																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2793	5	0	1	1	1	H2793_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		225																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2793	5	0	1	1	1	H2793_005_0	4	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1247.73	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2793	5	0	1	1	1	H2793_005_0	4	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	3		6																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2802	1	0	1	2	1	H2802_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	1	0	1	2	1	H2802_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	1	0	1	2	1	H2802_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	1	0	1	2	1	H2802_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	1	0	1	2	1	H2802_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				769	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	7	0	1	2	1	H2802_007_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	7	0	1	2	1	H2802_007_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	7	0	1	2	1	H2802_007_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	7	0	1	2	1	H2802_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	7	0	1	2	1	H2802_007_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				749	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	8	0	1	2	1	H2802_008_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	8	0	1	2	1	H2802_008_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	8	0	1	2	1	H2802_008_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	8	0	1	2	1	H2802_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	8	0	1	2	1	H2802_008_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				724	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	10	0	1	2	1	H2802_010_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	10	0	1	2	1	H2802_010_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	10	0	1	2	1	H2802_010_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	10	0	1	2	1	H2802_010_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	10	0	1	2	1	H2802_010_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				896	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	12	0	1	2	1	H2802_012_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	12	0	1	2	1	H2802_012_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	12	0	1	2	1	H2802_012_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	12	0	1	2	1	H2802_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	12	0	1	2	1	H2802_012_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				652	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	15	0	1	2	1	H2802_015_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	15	0	1	2	1	H2802_015_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	15	0	1	2	1	H2802_015_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	15	0	1	2	1	H2802_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	15	0	1	2	1	H2802_015_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				934	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	16	0	1	2	1	H2802_016_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	16	0	1	2	1	H2802_016_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	16	0	1	2	1	H2802_016_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	16	0	1	2	1	H2802_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	16	0	1	2	1	H2802_016_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				783	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	18	0	1	2	1	H2802_018_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	18	0	1	2	1	H2802_018_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	18	0	1	2	1	H2802_018_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	18	0	1	2	1	H2802_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	18	0	1	2	1	H2802_018_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				793	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	20	0	1	2	1	H2802_020_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	20	0	1	2	1	H2802_020_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	20	0	1	2	1	H2802_020_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	20	0	1	2	1	H2802_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	20	0	1	2	1	H2802_020_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				662	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	24	0	1	1	1	H2802_024_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	24	0	1	1	1	H2802_024_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	24	0	1	1	1	H2802_024_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	24	0	1	1	1	H2802_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	24	0	1	1	1	H2802_024_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1021	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	25	0	1	1	1	H2802_025_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	25	0	1	1	1	H2802_025_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	25	0	1	1	1	H2802_025_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	25	0	1	1	1	H2802_025_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	25	0	1	1	1	H2802_025_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				951	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	26	0	1	1	1	H2802_026_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	26	0	1	1	1	H2802_026_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	26	0	1	1	1	H2802_026_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	26	0	1	1	1	H2802_026_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	26	0	1	1	1	H2802_026_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1030	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	28	0	1	2	1	H2802_028_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	28	0	1	2	1	H2802_028_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	28	0	1	2	1	H2802_028_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	28	0	1	2	1	H2802_028_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	28	0	1	2	1	H2802_028_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				916	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	29	0	1	2	1	H2802_029_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	29	0	1	2	1	H2802_029_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	29	0	1	2	1	H2802_029_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	29	0	1	2	1	H2802_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	29	0	1	2	1	H2802_029_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				902	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	30	0	1	2	1	H2802_030_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	30	0	1	2	1	H2802_030_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	30	0	1	2	1	H2802_030_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	30	0	1	2	1	H2802_030_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	30	0	1	2	1	H2802_030_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				920	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	31	0	1	2	1	H2802_031_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		8																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	31	0	1	2	1	H2802_031_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		28																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	31	0	1	2	1	H2802_031_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	31	0	1	2	1	H2802_031_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	31	0	1	2	1	H2802_031_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				888	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	32	0	1	2	1	H2802_032_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		8																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	32	0	1	2	1	H2802_032_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	15		30																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	32	0	1	2	1	H2802_032_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	32	0	1	2	1	H2802_032_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	32	0	1	2	1	H2802_032_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				833	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	33	0	1	2	1	H2802_033_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		8																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	33	0	1	2	1	H2802_033_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		28																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	33	0	1	2	1	H2802_033_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	33	0	1	2	1	H2802_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	33	0	1	2	1	H2802_033_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				910	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	34	0	1	2	1	H2802_034_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	34	0	1	2	1	H2802_034_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	34	0	1	2	1	H2802_034_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	34	0	1	2	1	H2802_034_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	34	0	1	2	1	H2802_034_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				689	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	35	0	1	2	1	H2802_035_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	35	0	1	2	1	H2802_035_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	35	0	1	2	1	H2802_035_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	35	0	1	2	1	H2802_035_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	35	0	1	2	1	H2802_035_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				802	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	41	0	1	1	1	H2802_041_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	41	0	1	1	1	H2802_041_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	41	0	1	1	1	H2802_041_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	41	0	1	1	1	H2802_041_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	41	0	1	1	1	H2802_041_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				894	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	42	0	1	1	1	H2802_042_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	42	0	1	1	1	H2802_042_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	42	0	1	1	1	H2802_042_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	42	0	1	1	1	H2802_042_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	42	0	1	1	1	H2802_042_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1104	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	48	0	1	1	1	H2802_048_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	48	0	1	1	1	H2802_048_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	48	0	1	1	1	H2802_048_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	48	0	1	1	1	H2802_048_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	48	0	1	1	1	H2802_048_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				817	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	49	0	1	2	1	H2802_049_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	49	0	1	2	1	H2802_049_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	49	0	1	2	1	H2802_049_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	49	0	1	2	1	H2802_049_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2802	49	0	1	2	1	H2802_049_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				917	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	13	0	1	9	4	H2816_013_0	8	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		12.5					0		0											5		12.5				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	13	0	1	9	4	H2816_013_0	8	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								10		25					5		12.5											10		25				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	13	0	1	9	4	H2816_013_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		112.5					35		87.5											45		112.5				35		70				45				45			1.5	1.17		1.5	1.17	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	13	0	1	9	4	H2816_013_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								85		212.5					75		187.5											85		212.5				75		150				85				85			2.83	2.5		2.83	2.5	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	13	0	1	9	4	H2816_013_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	19	0	1	9	4	H2816_019_0	8	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								7		17.5					1		2.5											7		17.5				1		0				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	19	0	1	9	4	H2816_019_0	8	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		30					7		17.5											12		30				7		0				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	19	0	1	9	4	H2816_019_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		117.5					37		92.5											47		117.5				37		74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	19	0	1	9	4	H2816_019_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								100		250					90		225											100		250				90		180				100				100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2816	19	0	1	9	4	H2816_019_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	1	0	1	1	1	H2825_001_0	4	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	12																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	1	0	1	1	1	H2825_001_0	4	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	36																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	1	0	1	1	1	H2825_001_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								44	88	132					39	78	117					44	88	132																44				44			1.47	1.3	1.47			1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	1	0	1	1	1	H2825_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	285					90	180	270					95	190	285																95				95			3.17	3	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	1	0	1	1	1	H2825_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	2	0	1	1	1	H2825_002_0	4	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					2	4	6					12	24	36																12				12			0.4	0.07	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	2	0	1	1	1	H2825_002_0	4	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	51					7	14	21					17	34	51																17				17			0.57	0.23	0.57			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	2	0	1	1	1	H2825_002_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	141																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	2	0	1	1	1	H2825_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	300																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2825	2	0	1	1	1	H2825_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2829	1	0	1	1	1	H2829_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2829	1	0	1	1	1	H2829_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2829	1	0	1	1	1	H2829_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2829	1	0	1	1	1	H2829_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2829	1	0	1	1	1	H2829_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2829	1	0	1	1	1	H2829_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2829	1	0	1	1	1	H2829_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.69	33						632.23	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H2879	1	0	1	1	1	H2879_001_0	9	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2879	1	0	1	1	1	H2879_001_0	9	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2879	1	0	1	1	1	H2879_001_0	9	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	47	94	141																			47	94	141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2879	1	0	1	1	1	H2879_001_0	9	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				95.82	42	42	42																		42	42	42															42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2879	1	0	1	1	1	H2879_001_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				516.66	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2915	3	0	1	1	1	H2915_003_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	3	0	1	1	1	H2915_003_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	3	0	1	1	1	H2915_003_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	3	0	1	1	1	H2915_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	3	0	1	1	1	H2915_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	3	0	1	1	1	H2915_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	6	0	1	1	1	H2915_006_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	6	0	1	1	1	H2915_006_0	3	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	6	0	1	1	1	H2915_006_0	3	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	6	0	1	1	1	H2915_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	6	0	1	1	1	H2915_006_0	3	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2915	6	0	1	1	1	H2915_006_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2944	13	0	1	9	4	H2944_013_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	13	0	1	9	4	H2944_013_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					14		42											20		60				14		0				20				20			0.67	0.47		0.67	0.47	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	13	0	1	9	4	H2944_013_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	13	0	1	9	4	H2944_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	13	0	1	9	4	H2944_013_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	114	0	1	9	4	H2944_114_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	114	0	1	9	4	H2944_114_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	114	0	1	9	4	H2944_114_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	114	0	1	9	4	H2944_114_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	114	0	1	9	4	H2944_114_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	127	0	1	9	4	H2944_127_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	127	0	1	9	4	H2944_127_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	127	0	1	9	4	H2944_127_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	127	0	1	9	4	H2944_127_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2944	127	0	1	9	4	H2944_127_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2960	4	0	1	1	1	H2960_004_0	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	4		10																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	4	0	1	1	1	H2960_004_0	4	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	14		35																					28																14				14		0.47						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	4	0	1	1	1	H2960_004_0	4	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		117.5																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	4	0	1	1	1	H2960_004_0	4	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		250																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	4	0	1	1	1	H2960_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				264	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	4	0	1	1	1	H2960_004_0	4	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	2		5																					0																2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	4	0	1	1	1	H2960_004_0	4	Select Care Drugs	4	1	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2960	12	0	1	1	1	H2960_012_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	5		12.5																					10																5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	12	0	1	1	1	H2960_012_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	16		40																					32																16				16		0.53						0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	12	0	1	1	1	H2960_012_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		117.5																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	12	0	1	1	1	H2960_012_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		250																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	12	0	1	1	1	H2960_012_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				264	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	12	0	1	1	1	H2960_012_0	5	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	2.5		6.25																					0																2.5				2.5		0.08						0.08	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	12	0	1	1	1	H2960_012_0	5	Select Care Drugs	4	1	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2960	18	0	1	1	1	H2960_018_0	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		7.5																					6																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	18	0	1	1	1	H2960_018_0	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	3		7.5																					6																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2960	18	0	1	1	1	H2960_018_0	4	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	12		30																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	18	0	1	1	1	H2960_018_0	4	Generic	4	1	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	12		30																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2960	18	0	1	1	1	H2960_018_0	4	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		117.5																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	18	0	1	1	1	H2960_018_0	4	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		250																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	18	0	1	1	1	H2960_018_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				264	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	18	0	1	1	1	H2960_018_0	4	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	18	0	1	1	1	H2960_018_0	4	Select Care Drugs	4	1	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2960	19	0	1	1	1	H2960_019_0	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		5																					0																2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	19	0	1	1	1	H2960_019_0	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	2		5																					0																2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2960	19	0	1	1	1	H2960_019_0	4	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		20																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	19	0	1	1	1	H2960_019_0	4	Generic	4	1	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	8		20																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2960	19	0	1	1	1	H2960_019_0	4	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		117.5																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	19	0	1	1	1	H2960_019_0	4	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		250																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	19	0	1	1	1	H2960_019_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				264	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	19	0	1	1	1	H2960_019_0	4	Select Care Drugs	4	1	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2960	19	0	1	1	1	H2960_019_0	4	Select Care Drugs	4	1	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2962	1	0	1	1	1	H2962_001_0	12	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	1	0	1	1	1	H2962_001_0	12	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	1	0	1	1	1	H2962_001_0	12	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	1	0	1	1	1	H2962_001_0	12	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	1	0	1	1	1	H2962_001_0	12	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	35	70	105																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	1	0	1	1	1	H2962_001_0	12	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	60	120	180																					120																60				60		2						1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	1	0	1	1	1	H2962_001_0	12	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				928.33	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	11	0	1	1	1	H2962_011_0	11	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	11	0	1	1	1	H2962_011_0	11	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	11	0	1	1	1	H2962_011_0	11	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	11	0	1	1	1	H2962_011_0	11	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	11	0	1	1	1	H2962_011_0	11	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	35	70	105																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	11	0	1	1	1	H2962_011_0	11	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	60	120	180																					120																60				60		2						1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	11	0	1	1	1	H2962_011_0	11	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				877.4	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	12	0	1	1	1	H2962_012_0	11	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	12	0	1	1	1	H2962_012_0	11	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	12	0	1	1	1	H2962_012_0	11	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	12	0	1	1	1	H2962_012_0	11	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	12	0	1	1	1	H2962_012_0	11	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	25	50	75																					50																25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	12	0	1	1	1	H2962_012_0	11	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	50	100	150																					100																50				50		1.67						1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	12	0	1	1	1	H2962_012_0	11	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1085.85	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	3	1	1	1	H2962_013_3	11	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	3	1	1	1	H2962_013_3	11	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	13	3	1	1	1	H2962_013_3	11	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	3	1	1	1	H2962_013_3	11	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	13	3	1	1	1	H2962_013_3	11	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	35	70	105																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	3	1	1	1	H2962_013_3	11	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	60	120	180																					120																60				60		2						1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	3	1	1	1	H2962_013_3	11	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				892.06	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	4	1	1	1	H2962_013_4	11	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	4	1	1	1	H2962_013_4	11	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	13	4	1	1	1	H2962_013_4	11	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	4	1	1	1	H2962_013_4	11	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	13	4	1	1	1	H2962_013_4	11	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	35	70	105																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	4	1	1	1	H2962_013_4	11	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	60	120	180																					120																60				60		2						1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	13	4	1	1	1	H2962_013_4	11	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				892.06	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	1	1	1	1	H2962_014_1	11	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	1	1	1	1	H2962_014_1	11	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	14	1	1	1	1	H2962_014_1	11	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	1	1	1	1	H2962_014_1	11	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	14	1	1	1	1	H2962_014_1	11	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	25	50	75																					50																25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	1	1	1	1	H2962_014_1	11	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	50	100	150																					100																50				50		1.67						1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	1	1	1	1	H2962_014_1	11	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1043.87	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	2	1	1	1	H2962_014_2	11	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	2	1	1	1	H2962_014_2	11	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	14	2	1	1	1	H2962_014_2	11	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	2	1	1	1	H2962_014_2	11	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	14	2	1	1	1	H2962_014_2	11	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	25	50	75																					50																25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	2	1	1	1	H2962_014_2	11	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	50	100	150																					100																50				50		1.67						1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	14	2	1	1	1	H2962_014_2	11	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1043.87	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	16	0	1	1	1	H2962_016_0	12	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	16	0	1	1	1	H2962_016_0	12	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	16	0	1	1	1	H2962_016_0	12	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	16	0	1	1	1	H2962_016_0	12	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	16	0	1	1	1	H2962_016_0	12	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	30	60	90																					60																30				30		1						0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	16	0	1	1	1	H2962_016_0	12	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	70	140	210																					140																70				70		2.33						2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	16	0	1	1	1	H2962_016_0	12	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1085.75	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	18	0	1	1	1	H2962_018_0	13	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	18	0	1	1	1	H2962_018_0	13	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	18	0	1	1	1	H2962_018_0	13	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	18	0	1	1	1	H2962_018_0	13	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	8	16	24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H2962	18	0	1	1	1	H2962_018_0	13	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	30	60	90																					60																30				30		1						0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	18	0	1	1	1	H2962_018_0	13	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	70	140	210																					140																70				70		2.33						2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	18	0	1	1	1	H2962_018_0	13	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1085.75	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H2962	19	1	1	1	1	H2962_019_1	12	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	1	1	1	1	H2962_019_1	12	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	19	1	1	1	1	H2962_019_1	12	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	1	1	1	1	H2962_019_1	12	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	19	1	1	1	1	H2962_019_1	12	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	60																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	1	1	1	1	H2962_019_1	12	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	60	120	180																					120																60				60		2						1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	1	1	1	1	H2962_019_1	12	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1010.63	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	1	1	1	1	H2962_019_1	12	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	1	1	1	1	H2962_019_1	12	Select Care Drugs	4	11	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	19	2	1	1	1	H2962_019_2	12	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	2	1	1	1	H2962_019_2	12	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	19	2	1	1	1	H2962_019_2	12	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	2	1	1	1	H2962_019_2	12	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	19	2	1	1	1	H2962_019_2	12	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	60																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	2	1	1	1	H2962_019_2	12	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	60	120	180																					120																60				60		2						1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	2	1	1	1	H2962_019_2	12	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1010.63	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	2	1	1	1	H2962_019_2	12	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	19	2	1	1	1	H2962_019_2	12	Select Care Drugs	4	11	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	21	0	1	1	1	H2962_021_0	11	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	21	0	1	1	1	H2962_021_0	11	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	21	0	1	1	1	H2962_021_0	11	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	21	0	1	1	1	H2962_021_0	11	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2962	21	0	1	1	1	H2962_021_0	11	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	25	50	75																					50																25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	21	0	1	1	1	H2962_021_0	11	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	60	120	180																					120																60				60		2						1.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	21	0	1	1	1	H2962_021_0	11	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1036.22	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	21	0	1	1	1	H2962_021_0	11	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H2962	21	0	1	1	1	H2962_021_0	11	Select Care Drugs	4	11	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H2986	1	0	1	1	1	H2986_001_0	17	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	1	0	1	1	1	H2986_001_0	17	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	1	0	1	1	1	H2986_001_0	17	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	1	0	1	1	1	H2986_001_0	17	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	1	0	1	1	1	H2986_001_0	17	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	1	0	1	1	1	H2986_001_0	17	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				200	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	1	0	1	1	1	H2986_001_0	17	Select Care Drugs	4	1	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	1	0	1	1	1	H2986_001_0	17	Select Care Drugs	4	1	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	2	0	1	1	1	H2986_002_0	17	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	2	0	1	1	1	H2986_002_0	17	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	2	0	1	1	1	H2986_002_0	17	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	2	0	1	1	1	H2986_002_0	17	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	2	0	1	1	1	H2986_002_0	17	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	2	0	1	1	1	H2986_002_0	17	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				200	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	2	0	1	1	1	H2986_002_0	17	Select Care Drugs	4	1	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	2	0	1	1	1	H2986_002_0	17	Select Care Drugs	4	1	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	4	0	1	1	1	H2986_004_0	16	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	4	0	1	1	1	H2986_004_0	16	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	4	0	1	1	1	H2986_004_0	16	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	4	0	1	1	1	H2986_004_0	16	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	4	0	1	1	1	H2986_004_0	16	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	4	0	1	1	1	H2986_004_0	16	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				200	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	4	0	1	1	1	H2986_004_0	16	Select Care Drugs	4	1	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	4	0	1	1	1	H2986_004_0	16	Select Care Drugs	4	1	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	5	0	1	1	1	H2986_005_0	17	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	5	0	1	1	1	H2986_005_0	17	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	5	0	1	1	1	H2986_005_0	17	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	5	0	1	1	1	H2986_005_0	17	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	5	0	1	1	1	H2986_005_0	17	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	5	0	1	1	1	H2986_005_0	17	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				200	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	5	0	1	1	1	H2986_005_0	17	Select Care Drugs	4	1	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	5	0	1	1	1	H2986_005_0	17	Select Care Drugs	4	1	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	6	0	1	1	1	H2986_006_0	17	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	6	0	1	1	1	H2986_006_0	17	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	6	0	1	1	1	H2986_006_0	17	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	6	0	1	1	1	H2986_006_0	17	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	6	0	1	1	1	H2986_006_0	17	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	6	0	1	1	1	H2986_006_0	17	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				200	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	6	0	1	1	1	H2986_006_0	17	Select Care Drugs	4	1	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	6	0	1	1	1	H2986_006_0	17	Select Care Drugs	4	1	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	7	0	1	1	1	H2986_007_0	17	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	7	0	1	1	1	H2986_007_0	17	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H2986	7	0	1	1	1	H2986_007_0	17	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	7	0	1	1	1	H2986_007_0	17	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	7	0	1	1	1	H2986_007_0	17	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	7	0	1	1	1	H2986_007_0	17	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				200	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	7	0	1	1	1	H2986_007_0	17	Select Care Drugs	4	1	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H2986	7	0	1	1	1	H2986_007_0	17	Select Care Drugs	4	1	1	2	6	3	111		1	100		1	30	60	90				1	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3071	2	0	1	1	1	H3071_002_0	4	Preferred Generic	4	11	1	2	1	1	111		1		111	1	30	60	90				1	2				30	60	90	30		31	1	0	0																									3	6	9				1	0	0				1				1		0.03				0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3071	2	0	1	1	1	H3071_002_0	4	Generic	4	11	1	2	2	1	111		1		111	1	30	60	90				1	2				30	60	90	30		31	7	7	5																									15	30	45				7	7	5				7				7		0.23				0.5	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3071	2	0	1	1	1	H3071_002_0	4	Preferred Brand	4	11	1	2	3	1	111		1		111	1	30	60	90				1	2				30	60	90	30		31	47	70.5	70.5																									105	210	315				47	70.5	70.5				47				47		1.57				3.5	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3071	2	0	1	1	1	H3071_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		1		111	1	30	60	90				1	2				30	60	90	30		31				81	50	50	50																								50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3071	2	0	1	1	1	H3071_002_0	4	Specialty Tier	4	11	1	1	5	1	111		1		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"												
H3113	8	0	1	1	1	H3113_008_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3113	8	0	1	1	1	H3113_008_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3113	8	0	1	1	1	H3113_008_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3113	8	0	1	1	1	H3113_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3113	8	0	1	1	1	H3113_008_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				637	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3132	1	0	1	1	1	H3132_001_0	5	Generic	4	1	1	1	1	1	110		1			1	30		90				1	2							30		34				16.22	20		20																																			20			20								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3132	1	0	1	1	1	H3132_001_0	5	Preferred Brand	4	11	1	1	2	1	110		1			1	30		90				1	2							30		34				97.42	15		15																																			15			15								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3132	1	0	1	1	1	H3132_001_0	5	Non-Preferred Brand	4	10	1	1	3	1	110		1			1	30		90				1	1							30		34				41.54	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3132	1	0	1	1	1	H3132_001_0	5	Specialty Tier	4	10	1	1	4	1	110		1			1	30		90				1	1							30		34				561.61	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3132	1	0	1	1	1	H3132_001_0	5	Select Care Drugs	4	1	1	1	5	1	110		1			1	30		90				1	2							30		34				0	0		0																																			0			0								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3132	1	0	1	1	1	H3132_001_0	5	Select Care Drugs	4	1	1	1	5	3	110		1			1	30		90				1	2							30		34				0	0		0																																			0			0								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3146	1	0	1	1	1	H3146_001_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	1	0	1	1	1	H3146_001_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3146	1	0	1	1	1	H3146_001_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	1	0	1	1	1	H3146_001_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3146	1	0	1	1	1	H3146_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	1	0	1	1	1	H3146_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	1	0	1	1	1	H3146_001_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											763.2	33						719.4	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	2	0	1	1	1	H3146_002_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	2	0	1	1	1	H3146_002_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	2	0	1	1	1	H3146_002_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	2	0	1	1	1	H3146_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	2	0	1	1	1	H3146_002_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				623.05	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	3	0	1	1	1	H3146_003_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	3	0	1	1	1	H3146_003_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	3	0	1	1	1	H3146_003_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	3	0	1	1	1	H3146_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3146	3	0	1	1	1	H3146_003_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				623.05	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	22	0	1	1	1	H3152_022_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	22	0	1	1	1	H3152_022_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	22	0	1	1	1	H3152_022_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	22	0	1	1	1	H3152_022_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	22	0	1	1	1	H3152_022_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	22	0	1	1	1	H3152_022_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	22	0	1	1	1	H3152_022_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											643.15	29						630.09	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	48	0	1	1	1	H3152_048_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	48	0	1	1	1	H3152_048_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	48	0	1	1	1	H3152_048_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	48	0	1	1	1	H3152_048_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	48	0	1	1	1	H3152_048_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	48	0	1	1	1	H3152_048_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	48	0	1	1	1	H3152_048_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											609.44	30						555.16	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	80	0	1	1	1	H3152_080_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	80	0	1	1	1	H3152_080_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	80	0	1	1	1	H3152_080_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	80	0	1	1	1	H3152_080_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	80	0	1	1	1	H3152_080_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	80	0	1	1	1	H3152_080_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	80	0	1	1	1	H3152_080_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											526.22	27						504.67	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	82	0	1	1	1	H3152_082_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	82	0	1	1	1	H3152_082_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	82	0	1	1	1	H3152_082_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	82	0	1	1	1	H3152_082_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	82	0	1	1	1	H3152_082_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	82	0	1	1	1	H3152_082_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	82	0	1	1	1	H3152_082_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											626.57	28						569.29	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	84	0	1	1	1	H3152_084_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	84	0	1	1	1	H3152_084_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	84	0	1	1	1	H3152_084_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	84	0	1	1	1	H3152_084_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	84	0	1	1	1	H3152_084_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	84	0	1	1	1	H3152_084_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	84	0	1	1	1	H3152_084_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											586.86	29						553.43	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	88	0	1	1	1	H3152_088_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	88	0	1	1	1	H3152_088_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	88	0	1	1	1	H3152_088_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	88	0	1	1	1	H3152_088_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	88	0	1	1	1	H3152_088_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	88	0	1	1	1	H3152_088_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	88	0	1	1	1	H3152_088_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											644.81	27						612.82	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	89	0	1	1	1	H3152_089_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	89	0	1	1	1	H3152_089_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	89	0	1	1	1	H3152_089_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	89	0	1	1	1	H3152_089_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3152	89	0	1	1	1	H3152_089_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	89	0	1	1	1	H3152_089_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3152	89	0	1	1	1	H3152_089_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											688.1	29						654.09	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3154	4	0	1	1	1	H3154_004_0	9	Preferred Generic	2	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	4	0	1	1	1	H3154_004_0	9	Generic	2	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					9	18	27					4.5	9	13.5																16				16			0.53	0.3	0.15			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	4	0	1	1	1	H3154_004_0	9	Preferred Brand	2	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								35	70	105					28	56	84					28	56	84																35				35			1.17	0.93	0.93			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	4	0	1	1	1	H3154_004_0	9	Non-Preferred Brand	2	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								70	140	210					60	120	180					60	120	180																70				70			2.33	2	2			2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	4	0	1	1	1	H3154_004_0	9	Specialty Tier	2	11	1	1	5	1		10	1			1				30											30		31											311.71	25						311.71	25																							25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	22	0	1	1	1	H3154_022_0	8	Preferred Generic	2	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	22	0	1	1	1	H3154_022_0	8	Generic	2	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					9	18	27					4.5	9	13.5																16				16			0.53	0.3	0.15			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	22	0	1	1	1	H3154_022_0	8	Preferred Brand	2	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								35	70	105					28	56	84					28	56	84																35				35			1.17	0.93	0.93			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	22	0	1	1	1	H3154_022_0	8	Non-Preferred Brand	2	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								70	140	210					60	120	180					60	120	180																70				70			2.33	2	2			2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	22	0	1	1	1	H3154_022_0	8	Specialty Tier	2	11	1	1	5	1		10	1			1				30											30		31											287.98	25						287.98	25																							25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3154	29	0	1	1	1	H3154_029_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					1	2	3					0.5	1	1.5																8				8			0.27	0.03	0.02			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	29	0	1	1	1	H3154_029_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					9	18	27					4.5	9	13.5																16				16			0.53	0.3	0.15			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	29	0	1	1	1	H3154_029_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	29	0	1	1	1	H3154_029_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											46.84	40	40	40				40.99	35	35	35				35	35	35															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	29	0	1	1	1	H3154_029_0	8	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											390.11	28						390.11	28																							28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	30	0	1	1	1	H3154_030_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					1	2	3					0.5	1	1.5																8				8			0.27	0.03	0.02			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	30	0	1	1	1	H3154_030_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					9	18	27					4.5	9	13.5																16				16			0.53	0.3	0.15			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	30	0	1	1	1	H3154_030_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	30	0	1	1	1	H3154_030_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											52.84	40	40	40				46.23	35	35	35				35	35	35															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	30	0	1	1	1	H3154_030_0	9	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											404.32	28						404.32	28																							28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	31	0	1	1	1	H3154_031_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					1	2	3					0.5	1	1.5																8				8			0.27	0.03	0.02			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	31	0	1	1	1	H3154_031_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					9	18	27					4.5	9	13.5																16				16			0.53	0.3	0.15			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	31	0	1	1	1	H3154_031_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	31	0	1	1	1	H3154_031_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											43.29	40	40	40				37.88	35	35	35				35	35	35															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	31	0	1	1	1	H3154_031_0	8	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											587.28	29						587.28	29																							29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	32	0	1	1	1	H3154_032_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					1	2	3					0.5	1	1.5																8				8			0.27	0.03	0.02			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	32	0	1	1	1	H3154_032_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					9	18	27					4.5	9	13.5																16				16			0.53	0.3	0.15			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	32	0	1	1	1	H3154_032_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	32	0	1	1	1	H3154_032_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											53.58	40	40	40				46.88	35	35	35				35	35	35															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	32	0	1	1	1	H3154_032_0	7	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											633.83	33						633.83	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	33	0	1	2	1	H3154_033_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					1	2	3					0.5	1	1.5																8				8			0.27	0.03	0.02			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	33	0	1	2	1	H3154_033_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					9	18	27					4.5	9	13.5																16				16			0.53	0.3	0.15			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	33	0	1	2	1	H3154_033_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	33	0	1	2	1	H3154_033_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											49.95	40	40	40				43.7	35	35	35				35	35	35															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3154	33	0	1	2	1	H3154_033_0	5	Specialty Tier	4	11	1	1	5	1		10	1			1				30											30		31											471.19	33						471.19	33																							33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	1	0	1	1	1	H3170_001_0	5	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					3	6	9					4	8	0																14				3			0.47	0.1	0.13			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	1	0	1	1	1	H3170_001_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					8	16	24					8	16	0																18				8			0.6	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	1	0	1	1	1	H3170_001_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				37			1.57	1.23	1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	1	0	1	1	1	H3170_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											71	45	45	45				70	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	1	0	1	1	1	H3170_001_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	28						1	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	2	0	1	2	1	H3170_002_0	5	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					2	4	6					2	4	0																12				2			0.4	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	2	0	1	2	1	H3170_002_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					8	16	24					8	16	0																18				8			0.6	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	2	0	1	2	1	H3170_002_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				37			1.57	1.23	1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	2	0	1	2	1	H3170_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											70	45	45	45				75	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3170	2	0	1	2	1	H3170_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3192	1	0	1	1	1	H3192_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	1	0	1	1	1	H3192_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3192	1	0	1	1	1	H3192_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	1	0	1	1	1	H3192_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3192	1	0	1	1	1	H3192_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	1	0	1	1	1	H3192_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	1	0	1	1	1	H3192_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											740.64	33						696.52	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	2	0	1	1	1	H3192_002_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	2	0	1	1	1	H3192_002_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3192	2	0	1	1	1	H3192_002_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	2	0	1	1	1	H3192_002_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3192	2	0	1	1	1	H3192_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	2	0	1	1	1	H3192_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	2	0	1	1	1	H3192_002_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											735.96	33						699.33	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	3	0	1	1	1	H3192_003_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	3	0	1	1	1	H3192_003_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3192	3	0	1	1	1	H3192_003_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	3	0	1	1	1	H3192_003_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3192	3	0	1	1	1	H3192_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	3	0	1	1	1	H3192_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3192	3	0	1	1	1	H3192_003_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											736.01	33						699.43	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3204	1	0	1	1	1	H3204_001_0	8	Preferred Generic	4	1	1	2	1	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	0	0	0																									0	0	0				0	0	0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	1	0	1	1	1	H3204_001_0	8	Generic	4	1	1	2	2	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	10	20	30																									10	20	30				10	20	20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	1	0	1	1	1	H3204_001_0	8	Preferred Brand	4	11	1	2	3	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	45	90	135																									45	90	135				45	90	112.5				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	1	0	1	1	1	H3204_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	95	190	285																									95	190	285				95	190	285				95				95		3.17				3.17	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	1	0	1	1	1	H3204_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	7	0	1	1	1	H3204_007_0	7	Preferred Generic	4	1	1	2	1	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	0	0	0																									0	0	0				0	0	0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	7	0	1	1	1	H3204_007_0	7	Preferred Generic	4	1	1	2	1	3	111		1		111	1	30	60	90				2	2				30	60	90	30		31	0	0	0																									0	0	0				0	0	0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3204	7	0	1	1	1	H3204_007_0	7	Generic	4	1	1	2	2	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	10	20	30																									10	20	30				10	20	20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	7	0	1	1	1	H3204_007_0	7	Generic	4	1	1	2	2	3	111		1		111	1	30	60	90				2	2				30	60	90	30		31	10	20	30																									10	20	30				10	20	20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3204	7	0	1	1	1	H3204_007_0	7	Preferred Brand	4	11	1	2	3	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	45	90	135																									45	90	135				45	90	112.5				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	7	0	1	1	1	H3204_007_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	95	190	285																									95	190	285				95	190	285				95				95		3.17				3.17	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3204	7	0	1	1	1	H3204_007_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3206	1	0	1	4	1	H3206_001_0	8	Preferred Generic	3	1	1	2	1	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	4	8	12																									4	8	12				4	8	8				4				4		0.13				0.13	0.13	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3206	1	0	1	4	1	H3206_001_0	8	Generic	3	1	1	2	2	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	10	20	30																									10	20	30				10	20	20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3206	1	0	1	4	1	H3206_001_0	8	Preferred Brand	3	11	1	2	3	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	45	90	135																									45	90	135				45	90	112.5				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3206	1	0	1	4	1	H3206_001_0	8	Non-Preferred Drug	3	11	1	2	4	1	111		1		111	1	30	60	90				2	2				30	60	90	30		31	95	190	285																									95	190	285				95	190	285				95				95		3.17				3.17	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3206	1	0	1	4	1	H3206_001_0	8	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3219	1	0	1	4	1	H3219_001_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	1	0	1	4	1	H3219_001_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	1	0	1	4	1	H3219_001_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	1	0	1	4	1	H3219_001_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	1	0	1	4	1	H3219_001_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	1	0	1	4	1	H3219_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	1	0	1	4	1	H3219_001_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											642.66	28						605.1	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	2	0	1	4	1	H3219_002_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	2	0	1	4	1	H3219_002_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	2	0	1	4	1	H3219_002_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	2	0	1	4	1	H3219_002_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	2	0	1	4	1	H3219_002_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	2	0	1	4	1	H3219_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	2	0	1	4	1	H3219_002_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											685.18	30						645.7	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	3	0	1	4	1	H3219_003_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	3	0	1	4	1	H3219_003_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	3	0	1	4	1	H3219_003_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	3	0	1	4	1	H3219_003_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	3	0	1	4	1	H3219_003_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	3	0	1	4	1	H3219_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	3	0	1	4	1	H3219_003_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											746.85	33						703.24	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	4	0	1	4	1	H3219_004_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	4	0	1	4	1	H3219_004_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	4	0	1	4	1	H3219_004_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	4	0	1	4	1	H3219_004_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3219	4	0	1	4	1	H3219_004_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	4	0	1	4	1	H3219_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3219	4	0	1	4	1	H3219_004_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											746.84	33						703.24	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3237	1	0	1	48	5	H3237_001_0	4	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6	0	3.6	0	3.6	0	3.6			
H3237	1	0	1	48	5	H3237_001_0	4	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95	0	8.95	0	8.95	0	8.95			
H3237	1	0	1	48	5	H3237_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H3237	2	0	1	48	5	H3237_002_0	4	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6	0	3.6	0	3.6	0	3.6			
H3237	2	0	1	48	5	H3237_002_0	4	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95	0	8.95	0	8.95	0	8.95			
H3237	2	0	1	48	5	H3237_002_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H3239	1	0	1	1	1	H3239_001_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	1	0	1	1	1	H3239_001_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	1	0	1	1	1	H3239_001_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	1	0	1	1	1	H3239_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	1	0	1	1	1	H3239_001_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				574.3	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	2	0	1	1	1	H3239_002_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	2	0	1	1	1	H3239_002_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	2	0	1	1	1	H3239_002_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	2	0	1	1	1	H3239_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	2	0	1	1	1	H3239_002_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				573.76	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	3	0	1	1	1	H3239_003_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	3	0	1	1	1	H3239_003_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	3	0	1	1	1	H3239_003_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	3	0	1	1	1	H3239_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3239	3	0	1	1	1	H3239_003_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				573.76	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3240	13	0	1	1	1	H3240_013_0	10	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	13	0	1	1	1	H3240_013_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	13	0	1	1	1	H3240_013_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	13	0	1	1	1	H3240_013_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	13	0	1	1	1	H3240_013_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	13	0	1	1	1	H3240_013_0	10	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	16	0	1	1	1	H3240_016_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	16	0	1	1	1	H3240_016_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	16	0	1	1	1	H3240_016_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	16	0	1	1	1	H3240_016_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	16	0	1	1	1	H3240_016_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	16	0	1	1	1	H3240_016_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	17	0	1	2	1	H3240_017_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	9	9																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	17	0	1	2	1	H3240_017_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	17	0	1	2	1	H3240_017_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	17	0	1	2	1	H3240_017_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	17	0	1	2	1	H3240_017_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	17	0	1	2	1	H3240_017_0	11	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	21	0	1	1	1	H3240_021_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	21	0	1	1	1	H3240_021_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H3240	21	0	1	1	1	H3240_021_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					13	26	39					13	39	39																13				13			0.43	0.43	0.43			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	21	0	1	1	1	H3240_021_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	21	0	1	1	1	H3240_021_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	21	0	1	1	1	H3240_021_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	21	0	1	1	1	H3240_021_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	21	0	1	1	1	H3240_021_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3240	22	0	1	1	1	H3240_022_0	6	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	22	0	1	1	1	H3240_022_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	22	0	1	1	1	H3240_022_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	22	0	1	1	1	H3240_022_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	22	0	1	1	1	H3240_022_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	22	0	1	1	1	H3240_022_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	22	0	1	1	1	H3240_022_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3240	24	0	1	2	1	H3240_024_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	24	0	1	2	1	H3240_024_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	12	12																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	24	0	1	2	1	H3240_024_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								43	86	129					43	86	129					43	129	129																43				43			1.43	1.43	1.43			1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	24	0	1	2	1	H3240_024_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	24	0	1	2	1	H3240_024_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3240	24	0	1	2	1	H3240_024_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3251	2	0	1	1	1	H3251_002_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3251	2	0	1	1	1	H3251_002_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3251	2	0	1	1	1	H3251_002_0	4	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3251	2	0	1	1	1	H3251_002_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3251	2	0	1	1	1	H3251_002_0	4	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3251	2	0	1	1	1	H3251_002_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3281	1	0	1	4	1	H3281_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	1	0	1	4	1	H3281_001_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	1	0	1	4	1	H3281_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	1	0	1	4	1	H3281_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	1	0	1	4	1	H3281_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				764.51	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	1	0	1	4	1	H3281_001_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	1	0	1	4	1	H3281_001_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3281	3	0	1	4	1	H3281_003_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	3	0	1	4	1	H3281_003_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	3	0	1	4	1	H3281_003_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	3	0	1	4	1	H3281_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	3	0	1	4	1	H3281_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				768.72	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	3	0	1	4	1	H3281_003_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	3	0	1	4	1	H3281_003_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3281	5	0	1	4	1	H3281_005_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	5	0	1	4	1	H3281_005_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		20																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	5	0	1	4	1	H3281_005_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	5	0	1	4	1	H3281_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	5	0	1	4	1	H3281_005_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				756.71	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	5	0	1	4	1	H3281_005_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3281	5	0	1	4	1	H3281_005_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3288	1	0	1	4	1	H3288_001_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	1	0	1	4	1	H3288_001_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	1	0	1	4	1	H3288_001_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	1	0	1	4	1	H3288_001_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	1	0	1	4	1	H3288_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	1	0	1	4	1	H3288_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	1	0	1	4	1	H3288_001_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.74	27						595.73	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	2	0	1	4	1	H3288_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	2	0	1	4	1	H3288_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	2	0	1	4	1	H3288_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	2	0	1	4	1	H3288_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	2	0	1	4	1	H3288_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	2	0	1	4	1	H3288_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	2	0	1	4	1	H3288_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.75	27						595.74	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	3	0	1	4	1	H3288_003_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	3	0	1	4	1	H3288_003_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	3	0	1	4	1	H3288_003_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	3	0	1	4	1	H3288_003_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	3	0	1	4	1	H3288_003_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	3	0	1	4	1	H3288_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	3	0	1	4	1	H3288_003_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.75	27						595.74	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	4	0	1	4	1	H3288_004_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	4	0	1	4	1	H3288_004_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	4	0	1	4	1	H3288_004_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	4	0	1	4	1	H3288_004_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	4	0	1	4	1	H3288_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	4	0	1	4	1	H3288_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	4	0	1	4	1	H3288_004_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.75	27						595.74	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	5	0	1	4	1	H3288_005_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	5	0	1	4	1	H3288_005_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	5	0	1	4	1	H3288_005_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	5	0	1	4	1	H3288_005_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	5	0	1	4	1	H3288_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	5	0	1	4	1	H3288_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	5	0	1	4	1	H3288_005_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.24	26						575.71	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	6	0	1	4	1	H3288_006_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	6	0	1	4	1	H3288_006_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	6	0	1	4	1	H3288_006_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	6	0	1	4	1	H3288_006_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	6	0	1	4	1	H3288_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	6	0	1	4	1	H3288_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	6	0	1	4	1	H3288_006_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.26	26						575.72	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	7	0	1	4	1	H3288_007_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	7	0	1	4	1	H3288_007_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	7	0	1	4	1	H3288_007_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	7	0	1	4	1	H3288_007_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	7	0	1	4	1	H3288_007_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	7	0	1	4	1	H3288_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	7	0	1	4	1	H3288_007_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.75	27						595.73	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	8	0	1	4	1	H3288_008_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	8	0	1	4	1	H3288_008_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	8	0	1	4	1	H3288_008_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	8	0	1	4	1	H3288_008_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	8	0	1	4	1	H3288_008_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	8	0	1	4	1	H3288_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	8	0	1	4	1	H3288_008_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.26	26						575.72	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	9	0	1	4	1	H3288_009_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	9	0	1	4	1	H3288_009_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	9	0	1	4	1	H3288_009_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	9	0	1	4	1	H3288_009_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	9	0	1	4	1	H3288_009_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	9	0	1	4	1	H3288_009_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	9	0	1	4	1	H3288_009_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.75	27						595.73	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	10	0	1	4	1	H3288_010_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	10	0	1	4	1	H3288_010_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	10	0	1	4	1	H3288_010_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	10	0	1	4	1	H3288_010_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	10	0	1	4	1	H3288_010_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	10	0	1	4	1	H3288_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	10	0	1	4	1	H3288_010_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.26	26						575.72	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	11	0	1	4	1	H3288_011_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	11	0	1	4	1	H3288_011_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	11	0	1	4	1	H3288_011_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	11	0	1	4	1	H3288_011_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	11	0	1	4	1	H3288_011_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	11	0	1	4	1	H3288_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	11	0	1	4	1	H3288_011_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.27	26						575.73	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	12	0	1	4	1	H3288_012_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	12	0	1	4	1	H3288_012_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	12	0	1	4	1	H3288_012_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	12	0	1	4	1	H3288_012_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	12	0	1	4	1	H3288_012_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	12	0	1	4	1	H3288_012_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	12	0	1	4	1	H3288_012_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.27	26						575.73	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	13	0	1	4	1	H3288_013_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	13	0	1	4	1	H3288_013_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	13	0	1	4	1	H3288_013_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	13	0	1	4	1	H3288_013_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	13	0	1	4	1	H3288_013_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	13	0	1	4	1	H3288_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	13	0	1	4	1	H3288_013_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.26	26						575.72	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	14	0	1	4	1	H3288_014_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	14	0	1	4	1	H3288_014_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	14	0	1	4	1	H3288_014_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	14	0	1	4	1	H3288_014_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	14	0	1	4	1	H3288_014_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	14	0	1	4	1	H3288_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	14	0	1	4	1	H3288_014_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.26	26						575.72	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	15	0	1	4	1	H3288_015_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	15	0	1	4	1	H3288_015_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	15	0	1	4	1	H3288_015_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	15	0	1	4	1	H3288_015_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	15	0	1	4	1	H3288_015_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	15	0	1	4	1	H3288_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	15	0	1	4	1	H3288_015_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.27	26						575.73	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	16	0	1	4	1	H3288_016_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	16	0	1	4	1	H3288_016_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	16	0	1	4	1	H3288_016_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	16	0	1	4	1	H3288_016_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	16	0	1	4	1	H3288_016_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	16	0	1	4	1	H3288_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	16	0	1	4	1	H3288_016_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.26	26						575.72	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	17	0	1	4	1	H3288_017_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	17	0	1	4	1	H3288_017_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	17	0	1	4	1	H3288_017_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	17	0	1	4	1	H3288_017_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	17	0	1	4	1	H3288_017_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	17	0	1	4	1	H3288_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	17	0	1	4	1	H3288_017_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											616.97	27						580.39	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	18	0	1	4	1	H3288_018_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	18	0	1	4	1	H3288_018_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	18	0	1	4	1	H3288_018_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	18	0	1	4	1	H3288_018_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	18	0	1	4	1	H3288_018_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	18	0	1	4	1	H3288_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	18	0	1	4	1	H3288_018_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											616.97	27						580.39	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	19	0	1	4	1	H3288_019_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	19	0	1	4	1	H3288_019_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	19	0	1	4	1	H3288_019_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	19	0	1	4	1	H3288_019_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	19	0	1	4	1	H3288_019_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	19	0	1	4	1	H3288_019_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	19	0	1	4	1	H3288_019_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											616.98	27						580.39	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	20	0	1	4	1	H3288_020_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	20	0	1	4	1	H3288_020_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	20	0	1	4	1	H3288_020_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	20	0	1	4	1	H3288_020_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	20	0	1	4	1	H3288_020_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	20	0	1	4	1	H3288_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	20	0	1	4	1	H3288_020_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											595.92	26						560.71	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	21	0	1	4	1	H3288_021_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	21	0	1	4	1	H3288_021_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	21	0	1	4	1	H3288_021_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	21	0	1	4	1	H3288_021_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	21	0	1	4	1	H3288_021_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	21	0	1	4	1	H3288_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	21	0	1	4	1	H3288_021_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											595.92	26						560.71	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	22	0	1	4	1	H3288_022_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	22	0	1	4	1	H3288_022_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	22	0	1	4	1	H3288_022_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	22	0	1	4	1	H3288_022_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	22	0	1	4	1	H3288_022_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	22	0	1	4	1	H3288_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	22	0	1	4	1	H3288_022_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											614.27	26						575.73	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	23	0	1	4	1	H3288_023_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	23	0	1	4	1	H3288_023_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	23	0	1	4	1	H3288_023_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	23	0	1	4	1	H3288_023_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	23	0	1	4	1	H3288_023_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	23	0	1	4	1	H3288_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	23	0	1	4	1	H3288_023_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	24	0	1	4	1	H3288_024_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	24	0	1	4	1	H3288_024_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	24	0	1	4	1	H3288_024_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	24	0	1	4	1	H3288_024_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	24	0	1	4	1	H3288_024_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	24	0	1	4	1	H3288_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	24	0	1	4	1	H3288_024_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	25	0	1	4	1	H3288_025_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	25	0	1	4	1	H3288_025_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	25	0	1	4	1	H3288_025_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	25	0	1	4	1	H3288_025_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	25	0	1	4	1	H3288_025_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	25	0	1	4	1	H3288_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	25	0	1	4	1	H3288_025_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	26	0	1	4	1	H3288_026_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	26	0	1	4	1	H3288_026_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	26	0	1	4	1	H3288_026_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	26	0	1	4	1	H3288_026_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	26	0	1	4	1	H3288_026_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	26	0	1	4	1	H3288_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	26	0	1	4	1	H3288_026_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	27	0	1	4	1	H3288_027_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	27	0	1	4	1	H3288_027_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	27	0	1	4	1	H3288_027_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	27	0	1	4	1	H3288_027_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	27	0	1	4	1	H3288_027_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	27	0	1	4	1	H3288_027_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	27	0	1	4	1	H3288_027_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	28	0	1	4	1	H3288_028_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	28	0	1	4	1	H3288_028_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	28	0	1	4	1	H3288_028_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	28	0	1	4	1	H3288_028_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	28	0	1	4	1	H3288_028_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	28	0	1	4	1	H3288_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	28	0	1	4	1	H3288_028_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	29	0	1	4	1	H3288_029_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	29	0	1	4	1	H3288_029_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	29	0	1	4	1	H3288_029_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	29	0	1	4	1	H3288_029_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	29	0	1	4	1	H3288_029_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	29	0	1	4	1	H3288_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	29	0	1	4	1	H3288_029_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	30	0	1	4	1	H3288_030_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	30	0	1	4	1	H3288_030_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	30	0	1	4	1	H3288_030_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	30	0	1	4	1	H3288_030_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	30	0	1	4	1	H3288_030_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	30	0	1	4	1	H3288_030_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	30	0	1	4	1	H3288_030_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.59	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	31	0	1	4	1	H3288_031_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	31	0	1	4	1	H3288_031_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	31	0	1	4	1	H3288_031_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	31	0	1	4	1	H3288_031_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	31	0	1	4	1	H3288_031_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	31	0	1	4	1	H3288_031_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	31	0	1	4	1	H3288_031_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	32	0	1	4	1	H3288_032_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	32	0	1	4	1	H3288_032_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	32	0	1	4	1	H3288_032_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	32	0	1	4	1	H3288_032_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	32	0	1	4	1	H3288_032_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	32	0	1	4	1	H3288_032_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	32	0	1	4	1	H3288_032_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.59	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	33	0	1	4	1	H3288_033_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	33	0	1	4	1	H3288_033_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	33	0	1	4	1	H3288_033_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	33	0	1	4	1	H3288_033_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	33	0	1	4	1	H3288_033_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	33	0	1	4	1	H3288_033_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	33	0	1	4	1	H3288_033_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.58	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	35	0	1	4	1	H3288_035_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	35	0	1	4	1	H3288_035_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	35	0	1	4	1	H3288_035_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	35	0	1	4	1	H3288_035_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	35	0	1	4	1	H3288_035_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	35	0	1	4	1	H3288_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	35	0	1	4	1	H3288_035_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.57	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	36	0	1	4	1	H3288_036_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	36	0	1	4	1	H3288_036_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	36	0	1	4	1	H3288_036_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	36	0	1	4	1	H3288_036_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	36	0	1	4	1	H3288_036_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	36	0	1	4	1	H3288_036_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	36	0	1	4	1	H3288_036_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.31	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	37	0	1	4	1	H3288_037_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	37	0	1	4	1	H3288_037_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	37	0	1	4	1	H3288_037_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	37	0	1	4	1	H3288_037_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	37	0	1	4	1	H3288_037_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	37	0	1	4	1	H3288_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	37	0	1	4	1	H3288_037_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.32	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	38	0	1	4	1	H3288_038_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	38	0	1	4	1	H3288_038_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	38	0	1	4	1	H3288_038_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	38	0	1	4	1	H3288_038_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	38	0	1	4	1	H3288_038_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	38	0	1	4	1	H3288_038_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	38	0	1	4	1	H3288_038_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.37	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	39	0	1	4	1	H3288_039_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	39	0	1	4	1	H3288_039_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	39	0	1	4	1	H3288_039_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	39	0	1	4	1	H3288_039_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	39	0	1	4	1	H3288_039_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	39	0	1	4	1	H3288_039_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	39	0	1	4	1	H3288_039_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.3	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	40	0	1	4	1	H3288_040_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	40	0	1	4	1	H3288_040_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	40	0	1	4	1	H3288_040_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	40	0	1	4	1	H3288_040_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	40	0	1	4	1	H3288_040_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	40	0	1	4	1	H3288_040_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	40	0	1	4	1	H3288_040_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.32	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	41	0	1	4	1	H3288_041_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	41	0	1	4	1	H3288_041_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	41	0	1	4	1	H3288_041_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	41	0	1	4	1	H3288_041_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	41	0	1	4	1	H3288_041_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	41	0	1	4	1	H3288_041_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	41	0	1	4	1	H3288_041_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.33	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	42	0	1	4	1	H3288_042_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	42	0	1	4	1	H3288_042_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	42	0	1	4	1	H3288_042_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	42	0	1	4	1	H3288_042_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	42	0	1	4	1	H3288_042_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	42	0	1	4	1	H3288_042_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	42	0	1	4	1	H3288_042_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.3	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	43	0	1	4	1	H3288_043_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	43	0	1	4	1	H3288_043_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	43	0	1	4	1	H3288_043_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	43	0	1	4	1	H3288_043_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	43	0	1	4	1	H3288_043_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	43	0	1	4	1	H3288_043_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	43	0	1	4	1	H3288_043_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											654.32	28						616.15	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	44	0	1	4	1	H3288_044_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	44	0	1	4	1	H3288_044_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	44	0	1	4	1	H3288_044_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	44	0	1	4	1	H3288_044_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	44	0	1	4	1	H3288_044_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	44	0	1	4	1	H3288_044_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	44	0	1	4	1	H3288_044_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.65	29						636.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	45	0	1	4	1	H3288_045_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								9	18	27					0	0	0											9	18	27				0	0	0					9			9			0.3	0		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	45	0	1	4	1	H3288_045_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	45	0	1	4	1	H3288_045_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					45	90	135											47	94	141				45	90	135					47			47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	45	0	1	4	1	H3288_045_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					98	196	294											100	200	300				98	196	294					100			100			3.33	3.27		3.33	3.27	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	45	0	1	4	1	H3288_045_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											652.79	25						656.02	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	46	0	1	4	1	H3288_046_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	46	0	1	4	1	H3288_046_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	46	0	1	4	1	H3288_046_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	46	0	1	4	1	H3288_046_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	46	0	1	4	1	H3288_046_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	46	0	1	4	1	H3288_046_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	46	0	1	4	1	H3288_046_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											612.07	26						574.69	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	47	0	1	4	1	H3288_047_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	47	0	1	4	1	H3288_047_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	47	0	1	4	1	H3288_047_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	47	0	1	4	1	H3288_047_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	47	0	1	4	1	H3288_047_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	47	0	1	4	1	H3288_047_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	47	0	1	4	1	H3288_047_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.71	29						634.37	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	48	0	1	4	1	H3288_048_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	48	0	1	4	1	H3288_048_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	48	0	1	4	1	H3288_048_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	48	0	1	4	1	H3288_048_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3288	48	0	1	4	1	H3288_048_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	48	0	1	4	1	H3288_048_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3288	48	0	1	4	1	H3288_048_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											633.47	27						594.73	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3293	1	0	1	1	1	H3293_001_0	6	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	1	0	1	1	1	H3293_001_0	6	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		1
H3293	1	0	1	1	1	H3293_001_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	1	0	1	1	1	H3293_001_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3293	1	0	1	1	1	H3293_001_0	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	1	0	1	1	1	H3293_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	5		15																					15																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	1	0	1	1	1	H3293_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1010.79	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	2	0	1	1	1	H3293_002_0	6	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	2	0	1	1	1	H3293_002_0	6	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		1
H3293	2	0	1	1	1	H3293_002_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	2	0	1	1	1	H3293_002_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3293	2	0	1	1	1	H3293_002_0	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	20		60																					60																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	2	0	1	1	1	H3293_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	75		225																					225																75				75		2.5						2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	2	0	1	1	1	H3293_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1007.17	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	3	0	1	1	1	H3293_003_0	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	3	0	1	1	1	H3293_003_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	20		60																					60																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	3	0	1	1	1	H3293_003_0	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	3	0	1	1	1	H3293_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	3	0	1	1	1	H3293_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1090.71	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	4	0	1	1	1	H3293_004_0	6	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	4	0	1	1	1	H3293_004_0	6	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		1
H3293	4	0	1	1	1	H3293_004_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	4	0	1	1	1	H3293_004_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3293	4	0	1	1	1	H3293_004_0	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	45		135																					135																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	4	0	1	1	1	H3293_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	4	0	1	1	1	H3293_004_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				623.45	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	5	0	1	1	1	H3293_005_0	6	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	5	0	1	1	1	H3293_005_0	6	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		1
H3293	5	0	1	1	1	H3293_005_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	5	0	1	1	1	H3293_005_0	6	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3293	5	0	1	1	1	H3293_005_0	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	5		15																					15																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	5	0	1	1	1	H3293_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	15		45																					45																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	5	0	1	1	1	H3293_005_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				984.09	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	6	0	1	1	1	H3293_006_0	6	Preferred Generic	4	11	3	1	1	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	6	0	1	1	1	H3293_006_0	6	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	6	0	1	1	1	H3293_006_0	6	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	6	0	1	1	1	H3293_006_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3293	6	0	1	1	1	H3293_006_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	15	0	1	2	1	H3305_015_0	11	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	15	0	1	2	1	H3305_015_0	11	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3305	15	0	1	2	1	H3305_015_0	11	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	15	0	1	2	1	H3305_015_0	11	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	40		120																			40		80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	15	0	1	2	1	H3305_015_0	11	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				97.73	27		27																		27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	15	0	1	2	1	H3305_015_0	11	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				757.15	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	21	0	1	2	1	H3305_021_0	10	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	21	0	1	2	1	H3305_021_0	10	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3305	21	0	1	2	1	H3305_021_0	10	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	21	0	1	2	1	H3305_021_0	10	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	35		105																			35		70																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	21	0	1	2	1	H3305_021_0	10	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				95.31	27		27																		27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	21	0	1	2	1	H3305_021_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				920.33	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	22	0	1	2	1	H3305_022_0	9	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	22	0	1	2	1	H3305_022_0	9	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3305	22	0	1	2	1	H3305_022_0	9	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	15		45																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	22	0	1	2	1	H3305_022_0	9	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	22	0	1	2	1	H3305_022_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				91.39	27		27																		27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	22	0	1	2	1	H3305_022_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1004.65	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	30	0	1	2	1	H3305_030_0	10	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	30	0	1	2	1	H3305_030_0	10	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	12		36																			12		24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	30	0	1	2	1	H3305_030_0	10	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	30	0	1	2	1	H3305_030_0	10	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				98.17	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	30	0	1	2	1	H3305_030_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				876.49	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	32	0	1	2	1	H3305_032_0	8	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	32	0	1	2	1	H3305_032_0	8	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	32	0	1	2	1	H3305_032_0	8	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	32	0	1	2	1	H3305_032_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				99.27	26		26																		26		26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3305	32	0	1	2	1	H3305_032_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				883.64	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	2	0	1	1	1	H3307_002_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	2	0	1	1	1	H3307_002_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	2	0	1	1	1	H3307_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	2	0	1	1	1	H3307_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	2	0	1	1	1	H3307_002_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				735	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	12	0	1	1	1	H3307_012_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	12	0	1	1	1	H3307_012_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	12	0	1	1	1	H3307_012_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	12	0	1	1	1	H3307_012_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	12	0	1	1	1	H3307_012_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				769	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	15	0	1	1	1	H3307_015_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	15	0	1	1	1	H3307_015_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	15	0	1	1	1	H3307_015_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	15	0	1	1	1	H3307_015_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	15	0	1	1	1	H3307_015_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				699	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	23	0	1	1	1	H3307_023_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	23	0	1	1	1	H3307_023_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	23	0	1	1	1	H3307_023_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	23	0	1	1	1	H3307_023_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	23	0	1	1	1	H3307_023_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				832	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	25	0	1	1	1	H3307_025_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	25	0	1	1	1	H3307_025_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	25	0	1	1	1	H3307_025_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	25	0	1	1	1	H3307_025_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3307	25	0	1	1	1	H3307_025_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				664	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3312	2	0	1	1	1	H3312_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	2	0	1	1	1	H3312_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	2	0	1	1	1	H3312_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	2	0	1	1	1	H3312_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	2	0	1	1	1	H3312_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	2	0	1	1	1	H3312_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	2	0	1	1	1	H3312_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											555.97	27						469.87	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	18	0	1	1	1	H3312_018_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	18	0	1	1	1	H3312_018_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	18	0	1	1	1	H3312_018_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	18	0	1	1	1	H3312_018_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	18	0	1	1	1	H3312_018_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	18	0	1	1	1	H3312_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	18	0	1	1	1	H3312_018_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											726.68	28						674.76	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	48	0	1	1	1	H3312_048_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	48	0	1	1	1	H3312_048_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	48	0	1	1	1	H3312_048_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	48	0	1	1	1	H3312_048_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	48	0	1	1	1	H3312_048_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	48	0	1	1	1	H3312_048_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	48	0	1	1	1	H3312_048_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											705.9	33						641.47	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	62	0	1	1	1	H3312_062_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	62	0	1	1	1	H3312_062_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	62	0	1	1	1	H3312_062_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	62	0	1	1	1	H3312_062_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	62	0	1	1	1	H3312_062_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	62	0	1	1	1	H3312_062_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	62	0	1	1	1	H3312_062_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											628.21	27						581.92	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	64	0	1	1	1	H3312_064_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	64	0	1	1	1	H3312_064_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	64	0	1	1	1	H3312_064_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	64	0	1	1	1	H3312_064_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	64	0	1	1	1	H3312_064_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	64	0	1	1	1	H3312_064_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	64	0	1	1	1	H3312_064_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.7	27						607.08	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	65	0	1	1	1	H3312_065_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	65	0	1	1	1	H3312_065_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	65	0	1	1	1	H3312_065_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	65	0	1	1	1	H3312_065_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	65	0	1	1	1	H3312_065_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	65	0	1	1	1	H3312_065_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	65	0	1	1	1	H3312_065_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.82	27						607.23	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	68	0	1	1	1	H3312_068_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	68	0	1	1	1	H3312_068_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	68	0	1	1	1	H3312_068_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	68	0	1	1	1	H3312_068_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3312	68	0	1	1	1	H3312_068_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	68	0	1	1	1	H3312_068_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3312	68	0	1	1	1	H3312_068_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.66	27						607.03	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3328	2	0	1	1	1	H3328_002_0	9	Preferred Generic	3	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	2	0	1	1	1	H3328_002_0	9	Generic	3	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	20		60																					40																20				20		0.67						0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	2	0	1	1	1	H3328_002_0	9	Preferred Brand	3	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		34	47		141																					94																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	2	0	1	1	1	H3328_002_0	9	Non-Preferred Drug	3	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		34	100		300																					200																100				100		3.33						2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	2	0	1	1	1	H3328_002_0	9	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		34				1038	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	17	0	1	1	1	H3328_017_0	8	Preferred Generic	3	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	17	0	1	1	1	H3328_017_0	8	Generic	3	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	20		60																					40																20				20		0.67						0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	17	0	1	1	1	H3328_017_0	8	Preferred Brand	3	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		34	47		141																					94																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	17	0	1	1	1	H3328_017_0	8	Non-Preferred Drug	3	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		34	100		300																					200																100				100		3.33						2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	17	0	1	1	1	H3328_017_0	8	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		34				1115	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	1	1	2	1	H3328_022_1	9	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	1	1	2	1	H3328_022_1	9	Generic	2	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	15		45																					30																15				15		0.5						0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	1	1	2	1	H3328_022_1	9	Preferred Brand	2	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		34				73	22		22																				18															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	1	1	2	1	H3328_022_1	9	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		34				91	33		33																				29															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	1	1	2	1	H3328_022_1	9	Specialty Tier	2	11	1	1	5	1	10		1	10		1	30								30						30		34				942	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	2	1	2	1	H3328_022_2	12	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	2	1	2	1	H3328_022_2	12	Generic	2	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	15		45																					30																15				15		0.5						0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	2	1	2	1	H3328_022_2	12	Preferred Brand	2	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		34				73	22		22																				18															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	2	1	2	1	H3328_022_2	12	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		34				91	33		33																				29															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	22	2	1	2	1	H3328_022_2	12	Specialty Tier	2	11	1	1	5	1	10		1	10		1	30								30						30		34				942	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	1	1	1	1	H3328_023_1	8	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	1	1	1	1	H3328_023_1	8	Generic	2	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	15		45																					30																15				15		0.5						0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	1	1	1	1	H3328_023_1	8	Preferred Brand	2	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		34				72	23		23																				19															23			23								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	1	1	1	1	H3328_023_1	8	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		34				65	25		25																				21															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	1	1	1	1	H3328_023_1	8	Specialty Tier	2	11	1	1	5	1	10		1	10		1	30								30						30		34				731	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	2	1	1	1	H3328_023_2	8	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	2	1	1	1	H3328_023_2	8	Generic	2	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	15		45																					30																15				15		0.5						0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	2	1	1	1	H3328_023_2	8	Preferred Brand	2	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		34				72	23		23																				19															23			23								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	2	1	1	1	H3328_023_2	8	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		34				65	25		25																				21															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	23	2	1	1	1	H3328_023_2	8	Specialty Tier	2	11	1	1	5	1	10		1	10		1	30								30						30		34				731	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	1	1	1	1	H3328_024_1	9	Preferred Generic	3	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	5		15																					10																5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	1	1	1	1	H3328_024_1	9	Generic	3	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	20		60																					40																20				20		0.67						0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	1	1	1	1	H3328_024_1	9	Preferred Brand	3	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		34	47		141																					94																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	1	1	1	1	H3328_024_1	9	Non-Preferred Drug	3	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		34	100		300																					200																100				100		3.33						2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	1	1	1	1	H3328_024_1	9	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		34				1624	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	2	1	1	1	H3328_024_2	9	Preferred Generic	3	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		34	5		15																					10																5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	2	1	1	1	H3328_024_2	9	Generic	3	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		34	20		60																					40																20				20		0.67						0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	2	1	1	1	H3328_024_2	9	Preferred Brand	3	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		34	47		141																					94																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	2	1	1	1	H3328_024_2	9	Non-Preferred Drug	3	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		34	100		300																					200																100				100		3.33						2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3328	24	2	1	1	1	H3328_024_2	9	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		34				1624	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	1	1	1	1	H3330_021_1	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								3	6	9					0	0	0					0	0	0																3				3			0.1	0	0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	1	1	1	1	H3330_021_1	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	1	1	1	1	H3330_021_1	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	1	1	1	1	H3330_021_1	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	1	1	1	1	H3330_021_1	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											341.94	29						341.94	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	2	1	1	1	H3330_021_2	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								3	6	9					0	0	0					0	0	0																3				3			0.1	0	0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	2	1	1	1	H3330_021_2	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	2	1	1	1	H3330_021_2	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	2	1	1	1	H3330_021_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	2	1	1	1	H3330_021_2	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											341.94	29						341.94	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	3	1	1	1	H3330_021_3	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								3	6	9					0	0	0					0	0	0																3				3			0.1	0	0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	3	1	1	1	H3330_021_3	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	3	1	1	1	H3330_021_3	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	3	1	1	1	H3330_021_3	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	3	1	1	1	H3330_021_3	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											341.94	29						341.94	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	4	1	1	1	H3330_021_4	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								3	6	9					0	0	0					0	0	0																3				3			0.1	0	0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	4	1	1	1	H3330_021_4	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	4	1	1	1	H3330_021_4	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	4	1	1	1	H3330_021_4	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	21	4	1	1	1	H3330_021_4	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											341.94	29						341.94	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	1	1	1	1	H3330_032_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	1	1	1	1	H3330_032_1	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	1	1	1	1	H3330_032_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	1	1	1	1	H3330_032_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	1	1	1	1	H3330_032_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											391.29	27						391.29	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	2	1	1	1	H3330_032_2	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	2	1	1	1	H3330_032_2	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	2	1	1	1	H3330_032_2	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	2	1	1	1	H3330_032_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	2	1	1	1	H3330_032_2	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											391.29	27						391.29	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	3	1	1	1	H3330_032_3	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	3	1	1	1	H3330_032_3	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	3	1	1	1	H3330_032_3	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	3	1	1	1	H3330_032_3	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	3	1	1	1	H3330_032_3	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											391.29	27						391.29	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	4	1	1	1	H3330_032_4	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	4	1	1	1	H3330_032_4	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	4	1	1	1	H3330_032_4	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	4	1	1	1	H3330_032_4	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	32	4	1	1	1	H3330_032_4	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											391.29	27						391.29	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	36	0	1	1	1	H3330_036_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	36	0	1	1	1	H3330_036_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	36	0	1	1	1	H3330_036_0	5	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	36	0	1	1	1	H3330_036_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	36	0	1	1	1	H3330_036_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											403.15	27						403.15	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	38	0	1	1	1	H3330_038_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								3	6	9					0	0	0					0	0	0																3				3			0.1	0	0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	38	0	1	1	1	H3330_038_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	38	0	1	1	1	H3330_038_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	38	0	1	1	1	H3330_038_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	38	0	1	1	1	H3330_038_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											296.56	29						296.56	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	1	1	1	1	H3330_039_1	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	1	1	1	1	H3330_039_1	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	1	1	1	1	H3330_039_1	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	1	1	1	1	H3330_039_1	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	1	1	1	1	H3330_039_1	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											302.32	25						302.32	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	2	1	1	1	H3330_039_2	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	2	1	1	1	H3330_039_2	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	2	1	1	1	H3330_039_2	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	2	1	1	1	H3330_039_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	39	2	1	1	1	H3330_039_2	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											302.32	25						302.32	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	40	0	1	1	1	H3330_040_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	40	0	1	1	1	H3330_040_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	40	0	1	1	1	H3330_040_0	3	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	40	0	1	1	1	H3330_040_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	40	0	1	1	1	H3330_040_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											424.8	25						424.8	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	1	1	2	1	H3330_041_1	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	1	1	2	1	H3330_041_1	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	1	1	2	1	H3330_041_1	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	1	1	2	1	H3330_041_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	1	1	2	1	H3330_041_1	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											393.79	28						393.79	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	2	1	2	1	H3330_041_2	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	2	1	2	1	H3330_041_2	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	2	1	2	1	H3330_041_2	5	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	2	1	2	1	H3330_041_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3330	41	2	1	2	1	H3330_041_2	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											393.79	28						393.79	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	14	0	1	4	1	H3335_014_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	14	0	1	4	1	H3335_014_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								13		26					8		16							16																13				8			0.43	0.27				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	14	0	1	4	1	H3335_014_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	14	0	1	4	1	H3335_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	14	0	1	4	1	H3335_014_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	15	0	1	4	1	H3335_015_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	15	0	1	4	1	H3335_015_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								11		22					6		12							12																11				6			0.37	0.2				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	15	0	1	4	1	H3335_015_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	15	0	1	4	1	H3335_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	15	0	1	4	1	H3335_015_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	18	0	1	4	1	H3335_018_0	8	Preferred Generic	3	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		30					10		20							20																15				10			0.5	0.33				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	18	0	1	4	1	H3335_018_0	8	Generic	3	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	18	0	1	4	1	H3335_018_0	8	Preferred Brand	3	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								45		90					40		80							80																45				40			1.5	1.33				1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	18	0	1	4	1	H3335_018_0	8	Non-Preferred Drug	3	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	18	0	1	4	1	H3335_018_0	8	Specialty Tier	3	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	25		25				1	25		25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	38	0	1	4	1	H3335_038_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	38	0	1	4	1	H3335_038_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								13		26					8		16							16																13				8			0.43	0.27				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	38	0	1	4	1	H3335_038_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	38	0	1	4	1	H3335_038_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	38	0	1	4	1	H3335_038_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	53	0	1	4	1	H3335_053_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	53	0	1	4	1	H3335_053_0	8	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								15		30					10		20							20																15				10			0.5	0.33				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	53	0	1	4	1	H3335_053_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	53	0	1	4	1	H3335_053_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3335	53	0	1	4	1	H3335_053_0	8	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	31		31				1	31		31						31															31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3342	19	0	1	4	1	H3342_019_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	9	9																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3342	19	0	1	4	1	H3342_019_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3342	19	0	1	4	1	H3342_019_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								43	86	129					38	76	114					38	114	114																43				43			1.43	1.27	1.27			1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3342	19	0	1	4	1	H3342_019_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								93	186	279					88	176	264					88	264	264																93				93			3.1	2.93	2.93			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3342	19	0	1	4	1	H3342_019_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3342	19	0	1	4	1	H3342_019_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3342	19	0	1	4	1	H3342_019_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3344	5	0	1	4	1	H3344_005_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	5	0	1	4	1	H3344_005_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		34	20		50																					50																20				20		0.67						0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	5	0	1	4	1	H3344_005_0	8	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		34	47		117.5																					117.5																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	5	0	1	4	1	H3344_005_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		34				87.42	40		40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	5	0	1	4	1	H3344_005_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					31																																					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	10	0	1	4	1	H3344_010_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	10	0	1	4	1	H3344_010_0	9	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3344	10	0	1	4	1	H3344_010_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		34	10		25																					25																10				10		0.33						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	10	0	1	4	1	H3344_010_0	9	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		34	45		112.5																					112.5																45				45		1.5						1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	10	0	1	4	1	H3344_010_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		34				76.3	40		40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3344	10	0	1	4	1	H3344_010_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	9	0	1	1	1	H3347_009_0	5	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	9	0	1	1	1	H3347_009_0	5	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	60																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	9	0	1	1	1	H3347_009_0	5	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	9	0	1	1	1	H3347_009_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	9	0	1	1	1	H3347_009_0	5	Specialty Tier	4	11	1	1	5	1	111		1	100		1	30	60	90				2	2			90				30		31				860.29	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	15	0	1	1	1	H3347_015_0	4	Preferred Generic	3	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					6																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	15	0	1	1	1	H3347_015_0	4	Generic	3	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	19	38	57																					38																19				19		0.63						0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	15	0	1	1	1	H3347_015_0	4	Preferred Brand	3	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	15	0	1	1	1	H3347_015_0	4	Non-Preferred Drug	3	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				67.93	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3347	15	0	1	1	1	H3347_015_0	4	Specialty Tier	3	11	1	1	5	1	111		1	100		1	30	60	90				2	2			90				30		31				662.67	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	2	0	1	2	1	H3351_002_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	2	0	1	2	1	H3351_002_0	8	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								10		20					5		10							10																10				5			0.33	0.17				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	2	0	1	2	1	H3351_002_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	2	0	1	2	1	H3351_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	2	0	1	2	1	H3351_002_0	8	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	6	0	1	2	1	H3351_006_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	6	0	1	2	1	H3351_006_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								17		34					12		24							24																17				12			0.57	0.4				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	6	0	1	2	1	H3351_006_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	6	0	1	2	1	H3351_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	6	0	1	2	1	H3351_006_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	10	0	1	1	1	H3351_010_0	6	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	10	0	1	1	1	H3351_010_0	6	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								15		30					10		20							20																15				10			0.5	0.33				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	10	0	1	1	1	H3351_010_0	6	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	10	0	1	1	1	H3351_010_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	10	0	1	1	1	H3351_010_0	6	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	11	0	1	1	1	H3351_011_0	6	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	11	0	1	1	1	H3351_011_0	6	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	11	0	1	1	1	H3351_011_0	6	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	11	0	1	1	1	H3351_011_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	11	0	1	1	1	H3351_011_0	6	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	29		29				1	29		29						29															29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	12	0	1	2	1	H3351_012_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	12	0	1	2	1	H3351_012_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								15		30					10		20							20																15				10			0.5	0.33				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	12	0	1	2	1	H3351_012_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	12	0	1	2	1	H3351_012_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	12	0	1	2	1	H3351_012_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	13	0	1	2	1	H3351_013_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	13	0	1	2	1	H3351_013_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	13	0	1	2	1	H3351_013_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	13	0	1	2	1	H3351_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	13	0	1	2	1	H3351_013_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	15	0	1	2	1	H3351_015_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								9		18					4		8							8																9				4			0.3	0.13				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	15	0	1	2	1	H3351_015_0	8	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								13		26					8		16							16																13				8			0.43	0.27				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	15	0	1	2	1	H3351_015_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								45		90					40		80							80																45				40			1.5	1.33				1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	15	0	1	2	1	H3351_015_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	15	0	1	2	1	H3351_015_0	8	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	33		33				1	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	16	0	1	1	1	H3351_016_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	16	0	1	1	1	H3351_016_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	16	0	1	1	1	H3351_016_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	16	0	1	1	1	H3351_016_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	16	0	1	1	1	H3351_016_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	26		26				1	26		26						26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	17	0	1	1	1	H3351_017_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	17	0	1	1	1	H3351_017_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								19		38					14		28							28																19				14			0.63	0.47				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	17	0	1	1	1	H3351_017_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	17	0	1	1	1	H3351_017_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	17	0	1	1	1	H3351_017_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	26		26				1	26		26						26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	18	0	1	2	1	H3351_018_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	18	0	1	2	1	H3351_018_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	18	0	1	2	1	H3351_018_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	18	0	1	2	1	H3351_018_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	18	0	1	2	1	H3351_018_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	27		27				1	27		27						27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	19	0	1	2	1	H3351_019_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	19	0	1	2	1	H3351_019_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								19		38					14		28							28																19				14			0.63	0.47				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	19	0	1	2	1	H3351_019_0	7	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	19	0	1	2	1	H3351_019_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3351	19	0	1	2	1	H3351_019_0	7	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	2			90				30		31											1	30		30				1	30		30						30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3359	1	0	1	1	1	H3359_001_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3359	1	0	1	1	1	H3359_001_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	10																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3359	1	0	1	1	1	H3359_001_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	47																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3359	1	0	1	1	1	H3359_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	100																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3359	1	0	1	1	1	H3359_001_0	7	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	17	0	1	1	1	H3362_017_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	17	0	1	1	1	H3362_017_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		34	10		25																					25																10				10		0.33						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	17	0	1	1	1	H3362_017_0	8	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		34	47		117.5																					117.5																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	17	0	1	1	1	H3362_017_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		34				91.93	40		40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	17	0	1	1	1	H3362_017_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					31																																					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	20	0	1	1	1	H3362_020_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		34	4		10																					10																4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	20	0	1	1	1	H3362_020_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		34	15		37.5																					37.5																15				15		0.5						0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	20	0	1	1	1	H3362_020_0	8	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				2	2			90				30		34				59.99	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	20	0	1	1	1	H3362_020_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		34				38.07	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	20	0	1	1	1	H3362_020_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	33	0	1	1	1	H3362_033_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	33	0	1	1	1	H3362_033_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		34	15		37.5																					37.5																15				15		0.5						0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	33	0	1	1	1	H3362_033_0	8	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		34	47		117.5																					117.5																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	33	0	1	1	1	H3362_033_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		34				91.61	45		45																				45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	33	0	1	1	1	H3362_033_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	35	0	1	1	1	H3362_035_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3362	35	0	1	1	1	H3362_035_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		34	20		50																					50																20				20		0.67						0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3362	35	0	1	1	1	H3362_035_0	5	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		34	47		117.5																					117.5																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3362	35	0	1	1	1	H3362_035_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		34				86.29	40		40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3362	35	0	1	1	1	H3362_035_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3362	35	0	1	1	1	H3362_035_0	5	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				2	2			90				30		34	10		25																					25																10				10		0.33						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3362	38	0	1	1	1	H3362_038_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		34	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	38	0	1	1	1	H3362_038_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		34	20		50																					50																20				20		0.67						0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	38	0	1	1	1	H3362_038_0	7	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		34	47		117.5																					117.5																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	38	0	1	1	1	H3362_038_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		34				98.51	44		44																				44															44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3362	38	0	1	1	1	H3362_038_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					26																																					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	1	0	1	1	1	H3379_001_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	1	0	1	1	1	H3379_001_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	1	0	1	1	1	H3379_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	1	0	1	1	1	H3379_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	1	0	1	1	1	H3379_001_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				697	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	39	0	1	1	1	H3379_039_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	39	0	1	1	1	H3379_039_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	39	0	1	1	1	H3379_039_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	39	0	1	1	1	H3379_039_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	39	0	1	1	1	H3379_039_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				924	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	40	0	1	1	1	H3379_040_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	40	0	1	1	1	H3379_040_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	40	0	1	1	1	H3379_040_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	40	0	1	1	1	H3379_040_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	40	0	1	1	1	H3379_040_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1021	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	41	0	1	1	1	H3379_041_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	41	0	1	1	1	H3379_041_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	41	0	1	1	1	H3379_041_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	41	0	1	1	1	H3379_041_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3379	41	0	1	1	1	H3379_041_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				756	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	13	0	1	1	1	H3384_013_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								9		27					4		12					4		0																9				9			0.3	0.13	0.13			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	13	0	1	1	1	H3384_013_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					10		30					10		25																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	13	0	1	1	1	H3384_013_0	4	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	13	0	1	1	1	H3384_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	13	0	1	1	1	H3384_013_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	19	0	1	1	1	H3384_019_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								7		21					2		6					2		0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	19	0	1	1	1	H3384_019_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					10		30					10		25																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	19	0	1	1	1	H3384_019_0	4	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	19	0	1	1	1	H3384_019_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	19	0	1	1	1	H3384_019_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	58	0	1	1	1	H3384_058_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								7		21					2		6					2		0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	58	0	1	1	1	H3384_058_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					10		30					10		25																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	58	0	1	1	1	H3384_058_0	4	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	58	0	1	1	1	H3384_058_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	58	0	1	1	1	H3384_058_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												29		29					29		29				29		29															29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	59	0	1	1	1	H3384_059_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								7		21					2		6					2		0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	59	0	1	1	1	H3384_059_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								13		39					8		24					8		20																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	59	0	1	1	1	H3384_059_0	4	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	59	0	1	1	1	H3384_059_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	59	0	1	1	1	H3384_059_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	62	0	1	1	1	H3384_062_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								7		21					2		6					2		0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	62	0	1	1	1	H3384_062_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								17		51					12		36					12		30																17				17			0.57	0.4	0.4			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	62	0	1	1	1	H3384_062_0	4	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	62	0	1	1	1	H3384_062_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	62	0	1	1	1	H3384_062_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	63	0	1	1	1	H3384_063_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								9		27					3		9					3		0																9				9			0.3	0.1	0.1			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	63	0	1	1	1	H3384_063_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					10		30					10		25																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	63	0	1	1	1	H3384_063_0	4	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	63	0	1	1	1	H3384_063_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	63	0	1	1	1	H3384_063_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												26		26					26		26				26		26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	64	0	1	1	1	H3384_064_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								5		15					0		0					0		0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	64	0	1	1	1	H3384_064_0	4	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								10		30					5		15					5		12.5																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	64	0	1	1	1	H3384_064_0	4	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	64	0	1	1	1	H3384_064_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3384	64	0	1	1	1	H3384_064_0	4	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												31		31					31		31				31		31															31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	2	0	1	1	1	H3388_002_0	14	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	2	0	1	1	1	H3388_002_0	14	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	11		33																									11		33				11		22				11				11		0.37				0.37	0.37	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	2	0	1	1	1	H3388_002_0	14	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		120																									40		120				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	2	0	1	1	1	H3388_002_0	14	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		270																									90		270				90		225				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	2	0	1	1	1	H3388_002_0	14	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				1588.16	33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	4	0	1	1	1	H3388_004_0	15	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		4				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	4	0	1	1	1	H3388_004_0	15	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	13		39																									13		39				13		26				13				13		0.43				0.43	0.43	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	4	0	1	1	1	H3388_004_0	15	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	42		126																									42		126				42		84				42				42		1.4				1.4	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	4	0	1	1	1	H3388_004_0	15	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	93		279																									93		279				93		232.5				93				93		3.1				3.1	3.1	3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	4	0	1	1	1	H3388_004_0	15	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				1662.83	33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	13	0	1	1	1	H3388_013_0	15	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		6				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	13	0	1	1	1	H3388_013_0	15	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		30				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	13	0	1	1	1	H3388_013_0	15	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	13	0	1	1	1	H3388_013_0	15	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	97		291																									97		291				97		242.5				97				97		3.23				3.23	3.23	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	13	0	1	1	1	H3388_013_0	15	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				1919.14	33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	14	0	1	1	1	H3388_014_0	17	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		6				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	14	0	1	1	1	H3388_014_0	17	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	17		51																									17		51				17		34				17				17		0.57				0.57	0.57	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	14	0	1	1	1	H3388_014_0	17	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	14	0	1	1	1	H3388_014_0	17	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		250				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3388	14	0	1	1	1	H3388_014_0	17	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				1399.46	27																										27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3404	3	1	1	4	1	H3404_003_1	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	1	1	4	1	H3404_003_1	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	12				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	1	1	4	1	H3404_003_1	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	1	1	4	1	H3404_003_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											60.11	50	50	50				60.11	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	1	1	4	1	H3404_003_1	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											981.56	33						981.56	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	1	1	4	1	H3404_003_1	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	1	1	4	1	H3404_003_1	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3404	3	2	1	4	1	H3404_003_2	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	2	1	4	1	H3404_003_2	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	12				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	2	1	4	1	H3404_003_2	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	2	1	4	1	H3404_003_2	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											60.11	50	50	50				60.11	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	2	1	4	1	H3404_003_2	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											981.56	33						981.56	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	2	1	4	1	H3404_003_2	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3404	3	2	1	4	1	H3404_003_2	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3416	1	4	1	4	1	H3416_001_4	4	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	4	1	4	1	H3416_001_4	4	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	4	1	4	1	H3416_001_4	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		117.5				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	4	1	4	1	H3416_001_4	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		250				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	4	1	4	1	H3416_001_4	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	5	1	4	1	H3416_001_5	4	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	5	1	4	1	H3416_001_5	4	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	5	1	4	1	H3416_001_5	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		117.5				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	5	1	4	1	H3416_001_5	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		250				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	1	5	1	4	1	H3416_001_5	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	2	1	4	1	H3416_002_2	5	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	2	1	4	1	H3416_002_2	5	Preferred Generic	4	1	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3416	2	2	1	4	1	H3416_002_2	5	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	2	1	4	1	H3416_002_2	5	Generic	4	1	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.13				0.13	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3416	2	2	1	4	1	H3416_002_2	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		117.5				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	2	1	4	1	H3416_002_2	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		250				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	2	1	4	1	H3416_002_2	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	3	1	4	1	H3416_002_3	5	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	3	1	4	1	H3416_002_3	5	Preferred Generic	4	1	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3416	2	3	1	4	1	H3416_002_3	5	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	3	1	4	1	H3416_002_3	5	Generic	4	1	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.13				0.13	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3416	2	3	1	4	1	H3416_002_3	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		117.5				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	3	1	4	1	H3416_002_3	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		250				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3416	2	3	1	4	1	H3416_002_3	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3418	1	0	1	4	1	H3418_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3418	1	0	1	4	1	H3418_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3418	1	0	1	4	1	H3418_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3418	1	0	1	4	1	H3418_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3418	1	0	1	4	1	H3418_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				699	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	1	0	1	4	1	H3442_001_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	1	0	1	4	1	H3442_001_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3442	1	0	1	4	1	H3442_001_0	5	Generic	4	1	3	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					0		0													60						0				20				20			0.66	0				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	1	0	1	4	1	H3442_001_0	5	Generic	4	1	3	2	2	3		110	1		100	1				30		90	2	2						90	30		31								20		60					0		0													60						0				20				20			0.66	0				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H3442	1	0	1	4	1	H3442_001_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	1	0	1	4	1	H3442_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	1	0	1	4	1	H3442_001_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											751	33		33				640	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	3	0	1	4	1	H3442_003_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	3	0	1	4	1	H3442_003_0	3	Generic	4	1	3	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	3	0	1	4	1	H3442_003_0	3	Generic	4	1	3	2	2	3		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H3442	3	0	1	4	1	H3442_003_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	3	0	1	4	1	H3442_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	3	0	1	4	1	H3442_003_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											727	29		29				639	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	4	0	1	4	1	H3442_004_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	4	0	1	4	1	H3442_004_0	3	Generic	4	1	3	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	4	0	1	4	1	H3442_004_0	3	Generic	4	1	3	2	2	3		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H3442	4	0	1	4	1	H3442_004_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	4	0	1	4	1	H3442_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3442	4	0	1	4	1	H3442_004_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											713	29		29				654	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3447	1	0	1	1	1	H3447_001_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	1	0	1	1	1	H3447_001_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	1	0	1	1	1	H3447_001_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	1	0	1	1	1	H3447_001_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	1	0	1	1	1	H3447_001_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	1	0	1	1	1	H3447_001_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	1	0	1	1	1	H3447_001_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	1	0	1	1	1	H3447_001_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	1	0	1	1	1	H3447_001_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H3447	3	0	1	1	1	H3447_003_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	3	0	1	1	1	H3447_003_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	3	0	1	1	1	H3447_003_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	3	0	1	1	1	H3447_003_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14.5	29	43.5					9.5	19	28.5					9.5	19	19																14.5				14.5			0.48	0.32	0.32			0.43	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	3	0	1	1	1	H3447_003_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	3	0	1	1	1	H3447_003_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	3	0	1	1	1	H3447_003_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	3	0	1	1	1	H3447_003_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	3	0	1	1	1	H3447_003_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H3447	4	0	1	1	1	H3447_004_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	4	0	1	1	1	H3447_004_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	4	0	1	1	1	H3447_004_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	4	0	1	1	1	H3447_004_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	4	0	1	1	1	H3447_004_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	4	0	1	1	1	H3447_004_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	4	0	1	1	1	H3447_004_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	4	0	1	1	1	H3447_004_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	4	0	1	1	1	H3447_004_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H3447	5	0	1	1	1	H3447_005_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	5	0	1	1	1	H3447_005_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17.5	35	52.5					12.5	25	37.5					12.5	25	25																17.5				17.5			0.58	0.42	0.42			0.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	5	0	1	1	1	H3447_005_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	5	0	1	1	1	H3447_005_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					90	180	270					90	180	180																95				95			3.17	3	3			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	5	0	1	1	1	H3447_005_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	5	0	1	1	1	H3447_005_0	8	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					10	20	30					10	20	20																10				10			0.33	0.33	0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	10	0	1	1	1	H3447_010_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	10	0	1	1	1	H3447_010_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	10	0	1	1	1	H3447_010_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	10	0	1	1	1	H3447_010_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	10	0	1	1	1	H3447_010_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	10	0	1	1	1	H3447_010_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	10	0	1	1	1	H3447_010_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	10	0	1	1	1	H3447_010_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	10	0	1	1	1	H3447_010_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H3447	11	0	1	1	1	H3447_011_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	11	0	1	1	1	H3447_011_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	11	0	1	1	1	H3447_011_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	11	0	1	1	1	H3447_011_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	11	0	1	1	1	H3447_011_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	11	0	1	1	1	H3447_011_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	11	0	1	1	1	H3447_011_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	11	0	1	1	1	H3447_011_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	11	0	1	1	1	H3447_011_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	12	0	1	1	1	H3447_012_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	12	0	1	1	1	H3447_012_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	12	0	1	1	1	H3447_012_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	12	0	1	1	1	H3447_012_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	12	0	1	1	1	H3447_012_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	12	0	1	1	1	H3447_012_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	12	0	1	1	1	H3447_012_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	12	0	1	1	1	H3447_012_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	12	0	1	1	1	H3447_012_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	13	0	1	1	1	H3447_013_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	13	0	1	1	1	H3447_013_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	13	0	1	1	1	H3447_013_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	13	0	1	1	1	H3447_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	13	0	1	1	1	H3447_013_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	13	0	1	1	1	H3447_013_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	13	0	1	1	1	H3447_013_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	14	0	1	1	1	H3447_014_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	14	0	1	1	1	H3447_014_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	14	0	1	1	1	H3447_014_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	14	0	1	1	1	H3447_014_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	14	0	1	1	1	H3447_014_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	14	0	1	1	1	H3447_014_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	14	0	1	1	1	H3447_014_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	18	0	1	1	1	H3447_018_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	18	0	1	1	1	H3447_018_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	18	0	1	1	1	H3447_018_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	18	0	1	1	1	H3447_018_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	18	0	1	1	1	H3447_018_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	18	0	1	1	1	H3447_018_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	18	0	1	1	1	H3447_018_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	18	0	1	1	1	H3447_018_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	18	0	1	1	1	H3447_018_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	19	0	1	1	1	H3447_019_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	19	0	1	1	1	H3447_019_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	19	0	1	1	1	H3447_019_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	19	0	1	1	1	H3447_019_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	19	0	1	1	1	H3447_019_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	19	0	1	1	1	H3447_019_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	19	0	1	1	1	H3447_019_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	19	0	1	1	1	H3447_019_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	20	0	1	1	1	H3447_020_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	20	0	1	1	1	H3447_020_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	20	0	1	1	1	H3447_020_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	20	0	1	1	1	H3447_020_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	20	0	1	1	1	H3447_020_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	20	0	1	1	1	H3447_020_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	20	0	1	1	1	H3447_020_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	20	0	1	1	1	H3447_020_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	20	0	1	1	1	H3447_020_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	21	0	1	1	1	H3447_021_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					0	0	0																7				7			0.23	0.07	0			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	21	0	1	1	1	H3447_021_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					9	18	27					9	18	18																14				14			0.47	0.3	0.3			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	21	0	1	1	1	H3447_021_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	21	0	1	1	1	H3447_021_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	21	0	1	1	1	H3447_021_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	21	0	1	1	1	H3447_021_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	21	0	1	1	1	H3447_021_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	22	0	1	1	1	H3447_022_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					0	0	0																7				7			0.23	0.07	0			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	22	0	1	1	1	H3447_022_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					9	18	27					9	18	18																14				14			0.47	0.3	0.3			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	22	0	1	1	1	H3447_022_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	22	0	1	1	1	H3447_022_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	22	0	1	1	1	H3447_022_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	22	0	1	1	1	H3447_022_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	22	0	1	1	1	H3447_022_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	23	0	1	1	1	H3447_023_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					2	4	4																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	23	0	1	1	1	H3447_023_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					9	18	27					9	18	18																14				14			0.47	0.3	0.3			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	23	0	1	1	1	H3447_023_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	23	0	1	1	1	H3447_023_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	23	0	1	1	1	H3447_023_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	23	0	1	1	1	H3447_023_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	23	0	1	1	1	H3447_023_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	24	0	1	1	1	H3447_024_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	24	0	1	1	1	H3447_024_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	24	0	1	1	1	H3447_024_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					9	18	27					9	27	27																9				9			0.3	0.3	0.3			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	24	0	1	1	1	H3447_024_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	24	0	1	1	1	H3447_024_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	24	0	1	1	1	H3447_024_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	24	0	1	1	1	H3447_024_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	24	0	1	1	1	H3447_024_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	25	0	1	1	1	H3447_025_0	6	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	25	0	1	1	1	H3447_025_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	25	0	1	1	1	H3447_025_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	25	0	1	1	1	H3447_025_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	25	0	1	1	1	H3447_025_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	25	0	1	1	1	H3447_025_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	25	0	1	1	1	H3447_025_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	26	0	1	1	1	H3447_026_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	26	0	1	1	1	H3447_026_0	7	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	26	0	1	1	1	H3447_026_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	26	0	1	1	1	H3447_026_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	26	0	1	1	1	H3447_026_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	26	0	1	1	1	H3447_026_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	26	0	1	1	1	H3447_026_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	26	0	1	1	1	H3447_026_0	7	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	26	0	1	1	1	H3447_026_0	7	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H3447	27	0	1	1	1	H3447_027_0	6	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	27	0	1	1	1	H3447_027_0	6	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H3447	27	0	1	1	1	H3447_027_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								16	32	48					16	32	48					16	48	48																16				16			0.53	0.53	0.53			0.47	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	27	0	1	1	1	H3447_027_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	27	0	1	1	1	H3447_027_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	27	0	1	1	1	H3447_027_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	27	0	1	1	1	H3447_027_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	27	0	1	1	1	H3447_027_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	28	0	1	1	1	H3447_028_0	6	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	28	0	1	1	1	H3447_028_0	6	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		1
H3447	28	0	1	1	1	H3447_028_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					10	20	30					10	30	30																10				10			0.33	0.33	0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	28	0	1	1	1	H3447_028_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	28	0	1	1	1	H3447_028_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	28	0	1	1	1	H3447_028_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	28	0	1	1	1	H3447_028_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	28	0	1	1	1	H3447_028_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	29	0	1	1	1	H3447_029_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	29	0	1	1	1	H3447_029_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3447	29	0	1	1	1	H3447_029_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								5	10	15					5	10	15					5	10	10																5				5			0.17	0.17	0.17			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	29	0	1	1	1	H3447_029_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	29	0	1	1	1	H3447_029_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	29	0	1	1	1	H3447_029_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	29	0	1	1	1	H3447_029_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3447	29	0	1	1	1	H3447_029_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	23	1	1	1	1	H3449_023_1	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	1	1	1	1	H3449_023_1	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	1	1	1	1	H3449_023_1	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	1	1	1	1	H3449_023_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											74.39	50	50	50				74.39	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	1	1	1	1	H3449_023_1	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											730.96	25						730.96	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	1	1	1	1	H3449_023_1	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	1	1	1	1	H3449_023_1	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	23	2	1	1	1	H3449_023_2	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	2	1	1	1	H3449_023_2	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	2	1	1	1	H3449_023_2	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	2	1	1	1	H3449_023_2	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											74.39	50	50	50				74.39	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	2	1	1	1	H3449_023_2	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											730.96	25						730.96	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	2	1	1	1	H3449_023_2	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	2	1	1	1	H3449_023_2	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	23	4	1	1	1	H3449_023_4	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	4	1	1	1	H3449_023_4	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	4	1	1	1	H3449_023_4	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	4	1	1	1	H3449_023_4	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											74.39	50	50	50				74.39	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	4	1	1	1	H3449_023_4	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											730.96	25						730.96	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	4	1	1	1	H3449_023_4	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	4	1	1	1	H3449_023_4	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	23	5	1	1	1	H3449_023_5	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	5	1	1	1	H3449_023_5	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	5	1	1	1	H3449_023_5	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	5	1	1	1	H3449_023_5	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											74.39	50	50	50				74.39	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	5	1	1	1	H3449_023_5	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											730.96	25						730.96	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	5	1	1	1	H3449_023_5	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	23	5	1	1	1	H3449_023_5	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	24	1	1	1	1	H3449_024_1	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	1	1	1	1	H3449_024_1	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	12				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	1	1	1	1	H3449_024_1	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	1	1	1	1	H3449_024_1	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											57.13	50	50	50				57.13	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	1	1	1	1	H3449_024_1	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											937.03	33						937.03	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	1	1	1	1	H3449_024_1	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	1	1	1	1	H3449_024_1	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	24	2	1	1	1	H3449_024_2	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	2	1	1	1	H3449_024_2	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	12				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	2	1	1	1	H3449_024_2	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	2	1	1	1	H3449_024_2	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											57.13	50	50	50				57.13	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	2	1	1	1	H3449_024_2	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											937.03	33						937.03	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	2	1	1	1	H3449_024_2	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	2	1	1	1	H3449_024_2	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	24	3	1	1	1	H3449_024_3	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	3	1	1	1	H3449_024_3	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	12				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	3	1	1	1	H3449_024_3	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	3	1	1	1	H3449_024_3	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											57.13	50	50	50				57.13	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	3	1	1	1	H3449_024_3	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											937.03	33						937.03	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	3	1	1	1	H3449_024_3	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	24	3	1	1	1	H3449_024_3	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								1	1	1					0	0	0											1	1	1				0	0	0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	25	0	1	1	1	H3449_025_0	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					3	6	9											15	30	45				3	6	6				15				15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	25	0	1	1	1	H3449_025_0	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	25	0	1	1	1	H3449_025_0	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	25	0	1	1	1	H3449_025_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											81.02	50	50	50				81.02	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	25	0	1	1	1	H3449_025_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											807.59	26						807.59	26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	25	0	1	1	1	H3449_025_0	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	25	0	1	1	1	H3449_025_0	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3449	26	0	1	1	1	H3449_026_0	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					0	0	0											15	30	45				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	26	0	1	1	1	H3449_026_0	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	12				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	26	0	1	1	1	H3449_026_0	7	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	26	0	1	1	1	H3449_026_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											67.18	50	50	50				67.18	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	26	0	1	1	1	H3449_026_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											843.11	33						843.11	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	26	0	1	1	1	H3449_026_0	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3449	26	0	1	1	1	H3449_026_0	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	3	3					0	0	0											3	3	3				0	0	0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3464	1	0	1	1	1	H3464_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	1	0	1	1	1	H3464_001_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	1	0	1	1	1	H3464_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	1	0	1	1	1	H3464_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	1	0	1	1	1	H3464_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				649	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	2	0	1	1	1	H3464_002_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	2	0	1	1	1	H3464_002_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	2	0	1	1	1	H3464_002_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	2	0	1	1	1	H3464_002_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	2	0	1	1	1	H3464_002_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1011	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	3	0	1	1	1	H3464_003_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	3	0	1	1	1	H3464_003_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	3	0	1	1	1	H3464_003_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	3	0	1	1	1	H3464_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	3	0	1	1	1	H3464_003_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				665	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	4	0	1	1	1	H3464_004_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	4	0	1	1	1	H3464_004_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	4	0	1	1	1	H3464_004_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	4	0	1	1	1	H3464_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	4	0	1	1	1	H3464_004_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				974	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	5	0	1	1	1	H3464_005_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	5	0	1	1	1	H3464_005_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	5	0	1	1	1	H3464_005_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	5	0	1	1	1	H3464_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	5	0	1	1	1	H3464_005_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				930	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	6	0	1	1	1	H3464_006_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	6	0	1	1	1	H3464_006_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	6	0	1	1	1	H3464_006_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	6	0	1	1	1	H3464_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3464	6	0	1	1	1	H3464_006_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1049	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	1	0	1	1	1	H3471_001_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	1	0	1	1	1	H3471_001_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	1	0	1	1	1	H3471_001_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	1	0	1	1	1	H3471_001_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											28.76	50	50	50				35.75	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	1	0	1	1	1	H3471_001_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3471	2	0	1	1	1	H3471_002_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	2	0	1	1	1	H3471_002_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	2	0	1	1	1	H3471_002_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	2	0	1	1	1	H3471_002_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											23.05	50	50	50				29.17	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	2	0	1	1	1	H3471_002_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3471	4	0	1	1	1	H3471_004_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	4	0	1	1	1	H3471_004_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	4	0	1	1	1	H3471_004_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	4	0	1	1	1	H3471_004_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											28.82	50	50	50				36.83	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	4	0	1	1	1	H3471_004_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3471	5	0	1	1	1	H3471_005_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	5	0	1	1	1	H3471_005_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	5	0	1	1	1	H3471_005_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	5	0	1	1	1	H3471_005_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											25.84	50	50	50				32.73	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	5	0	1	1	1	H3471_005_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3471	10	0	1	1	1	H3471_010_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	10	0	1	1	1	H3471_010_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	10	0	1	1	1	H3471_010_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	10	0	1	1	1	H3471_010_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											27.87	50	50	50				34.05	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	10	0	1	1	1	H3471_010_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3471	13	0	1	2	1	H3471_013_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	13	0	1	2	1	H3471_013_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	13	0	1	2	1	H3471_013_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	13	0	1	2	1	H3471_013_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											31.61	50	50	50				39.04	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	13	0	1	2	1	H3471_013_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3471	14	0	1	2	1	H3471_014_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	14	0	1	2	1	H3471_014_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	14	0	1	2	1	H3471_014_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	14	0	1	2	1	H3471_014_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											26.51	50	50	50				33.67	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	14	0	1	2	1	H3471_014_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3471	17	0	1	1	1	H3471_017_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					12	24	30																12				12			0.4	0	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	17	0	1	1	1	H3471_017_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					20	40	50					20	40	50																20				20			0.67	0.67	0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	17	0	1	1	1	H3471_017_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	117.5					47	94	117.5																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	17	0	1	1	1	H3471_017_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.81	50	50	50				39.61	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3471	17	0	1	1	1	H3471_017_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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"												
H3499	1	0	1	1	1	H3499_001_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	1	0	1	1	1	H3499_001_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	15																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	1	0	1	1	1	H3499_001_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	1	0	1	1	1	H3499_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	1	0	1	1	1	H3499_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	1	0	1	1	1	H3499_001_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	2	0	1	1	1	H3499_002_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	2	0	1	1	1	H3499_002_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	15																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	2	0	1	1	1	H3499_002_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	2	0	1	1	1	H3499_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	2	0	1	1	1	H3499_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	2	0	1	1	1	H3499_002_0	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	5	0	1	1	1	H3499_005_0	5	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	5	0	1	1	1	H3499_005_0	5	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	5	0	1	1	1	H3499_005_0	5	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	5	0	1	1	1	H3499_005_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	5	0	1	1	1	H3499_005_0	5	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3499	5	0	1	1	1	H3499_005_0	5	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3528	6	0	1	2	1	H3528_006_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	6	0	1	2	1	H3528_006_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3528	6	0	1	2	1	H3528_006_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	6	0	1	2	1	H3528_006_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3528	6	0	1	2	1	H3528_006_0	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	6	0	1	2	1	H3528_006_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	6	0	1	2	1	H3528_006_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											309.72	27						309.72	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	10	0	1	1	1	H3528_010_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	10	0	1	1	1	H3528_010_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	10	0	1	1	1	H3528_010_0	10	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	10	0	1	1	1	H3528_010_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	10	0	1	1	1	H3528_010_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											327.11	28						327.11	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	1	1	2	1	H3528_011_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	1	1	2	1	H3528_011_1	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	1	1	2	1	H3528_011_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	1	1	2	1	H3528_011_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	1	1	2	1	H3528_011_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											325.4	27						325.4	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	2	1	2	1	H3528_011_2	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	2	1	2	1	H3528_011_2	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	2	1	2	1	H3528_011_2	10	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	2	1	2	1	H3528_011_2	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	11	2	1	2	1	H3528_011_2	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											325.4	27						325.4	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	14	0	1	1	1	H3528_014_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	14	0	1	1	1	H3528_014_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	14	0	1	1	1	H3528_014_0	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	14	0	1	1	1	H3528_014_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	14	0	1	1	1	H3528_014_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											316.3	25						316.3	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	15	0	1	2	1	H3528_015_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	15	0	1	2	1	H3528_015_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	15	0	1	2	1	H3528_015_0	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	15	0	1	2	1	H3528_015_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	15	0	1	2	1	H3528_015_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											286.13	27						286.13	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	16	0	1	1	1	H3528_016_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	16	0	1	1	1	H3528_016_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					0	0	0																9				9			0.3	0.07	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3528	16	0	1	1	1	H3528_016_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	16	0	1	1	1	H3528_016_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	25																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3528	16	0	1	1	1	H3528_016_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	16	0	1	1	1	H3528_016_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3528	16	0	1	1	1	H3528_016_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											304.4	27						304.4	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	1	0	1	1	1	H3533_001_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	1	0	1	1	1	H3533_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	1	0	1	1	1	H3533_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	1	0	1	1	1	H3533_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	1	0	1	1	1	H3533_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	2	0	1	1	1	H3533_002_0	5	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	2	0	1	1	1	H3533_002_0	5	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	2	0	1	1	1	H3533_002_0	5	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	2	0	1	1	1	H3533_002_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	2	0	1	1	1	H3533_002_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	6	0	1	1	1	H3533_006_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	6	0	1	1	1	H3533_006_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	6	0	1	1	1	H3533_006_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	6	0	1	1	1	H3533_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	6	0	1	1	1	H3533_006_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	10	0	1	1	1	H3533_010_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	10	0	1	1	1	H3533_010_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	10	0	1	1	1	H3533_010_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	10	0	1	1	1	H3533_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	10	0	1	1	1	H3533_010_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	13	0	1	1	1	H3533_013_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	13	0	1	1	1	H3533_013_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	13	0	1	1	1	H3533_013_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	13	0	1	1	1	H3533_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	13	0	1	1	1	H3533_013_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	20	0	1	1	1	H3533_020_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	20	0	1	1	1	H3533_020_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	20	0	1	1	1	H3533_020_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	20	0	1	1	1	H3533_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	20	0	1	1	1	H3533_020_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	21	0	1	1	1	H3533_021_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	21	0	1	1	1	H3533_021_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	21	0	1	1	1	H3533_021_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	21	0	1	1	1	H3533_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	21	0	1	1	1	H3533_021_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	23	0	1	1	1	H3533_023_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	23	0	1	1	1	H3533_023_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	23	0	1	1	1	H3533_023_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	23	0	1	1	1	H3533_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	23	0	1	1	1	H3533_023_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	27	0	1	1	1	H3533_027_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	27	0	1	1	1	H3533_027_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	27	0	1	1	1	H3533_027_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	27	0	1	1	1	H3533_027_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	27	0	1	1	1	H3533_027_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	1	1	1	1	H3533_029_1	7	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	1	1	1	1	H3533_029_1	7	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	1	1	1	1	H3533_029_1	7	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	1	1	1	1	H3533_029_1	7	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	1	1	1	1	H3533_029_1	7	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	2	1	1	1	H3533_029_2	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	2	1	1	1	H3533_029_2	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	2	1	1	1	H3533_029_2	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	2	1	1	1	H3533_029_2	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	29	2	1	1	1	H3533_029_2	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	30	0	1	1	1	H3533_030_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					9		27											10		30				9		0				10				10			0.33	0.3		0.33	0.3	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	30	0	1	1	1	H3533_030_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	30	0	1	1	1	H3533_030_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	30	0	1	1	1	H3533_030_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3533	30	0	1	1	1	H3533_030_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3536	2	0	1	1	1	H3536_002_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	2	0	1	1	1	H3536_002_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	2	0	1	1	1	H3536_002_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	2	0	1	1	1	H3536_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	2	0	1	1	1	H3536_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	2	0	1	1	1	H3536_002_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	2	0	1	1	1	H3536_002_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3536	4	0	1	1	1	H3536_004_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	4	0	1	1	1	H3536_004_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3536	4	0	1	1	1	H3536_004_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	12	12																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	4	0	1	1	1	H3536_004_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								39	78	117					39	78	117					39	117	117																39				39			1.3	1.3	1.3			1.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	4	0	1	1	1	H3536_004_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	4	0	1	1	1	H3536_004_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	4	0	1	1	1	H3536_004_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	4	0	1	1	1	H3536_004_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3536	5	0	1	1	1	H3536_005_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	5	0	1	1	1	H3536_005_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	5	0	1	1	1	H3536_005_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	5	0	1	1	1	H3536_005_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	5	0	1	1	1	H3536_005_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	5	0	1	1	1	H3536_005_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3536	5	0	1	1	1	H3536_005_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3557	1	0	1	4	1	H3557_001_0	7	Preferred Generic	4	1	1	2	1	1	111		1	101		1	30	60	90				1	2		60	90				30		31	0	0	0																				0	0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3557	1	0	1	4	1	H3557_001_0	7	Preferred Generic	4	1	1	2	1	3	111		1	101		1	30	60	90				1	2		60	90				30		31	0	0	0																				0	0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3557	1	0	1	4	1	H3557_001_0	7	Generic	4	1	1	2	2	1	111		1	101		1	30	60	90				1	2		60	90				30		31	0	0	0																				0	0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3557	1	0	1	4	1	H3557_001_0	7	Generic	4	1	1	2	2	3	111		1	101		1	30	60	90				1	2		60	90				30		31	0	0	0																				0	0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3557	1	0	1	4	1	H3557_001_0	7	Preferred Brand	4	11	1	2	3	1	111		1	101		1	30	60	90				1	2		60	90				30		31	47	94	141																				94	117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3557	1	0	1	4	1	H3557_001_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		1	101		1	30	60	90				1	2		60	90				30		31	100	200	300																				200	250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3557	1	0	1	4	1	H3557_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3561	1	0	1	1	1	H3561_001_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	1	0	1	1	1	H3561_001_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	1	0	1	1	1	H3561_001_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	1	0	1	1	1	H3561_001_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	1	0	1	1	1	H3561_001_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	1	0	1	1	1	H3561_001_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	2	0	1	1	1	H3561_002_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	2	0	1	1	1	H3561_002_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	2	0	1	1	1	H3561_002_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	2	0	1	1	1	H3561_002_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	2	0	1	1	1	H3561_002_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	2	0	1	1	1	H3561_002_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	4	0	1	1	1	H3561_004_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	4	0	1	1	1	H3561_004_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	4	0	1	1	1	H3561_004_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	4	0	1	1	1	H3561_004_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	4	0	1	1	1	H3561_004_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	4	0	1	1	1	H3561_004_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	5	0	1	1	1	H3561_005_0	3	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	5	0	1	1	1	H3561_005_0	3	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	5	0	1	1	1	H3561_005_0	3	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	5	0	1	1	1	H3561_005_0	3	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	5	0	1	1	1	H3561_005_0	3	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	5	0	1	1	1	H3561_005_0	3	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	6	0	1	1	1	H3561_006_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	6	0	1	1	1	H3561_006_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	6	0	1	1	1	H3561_006_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	6	0	1	1	1	H3561_006_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	6	0	1	1	1	H3561_006_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3561	6	0	1	1	1	H3561_006_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3572	1	0	1	1	1	H3572_001_0	3	Generic	4	1	1	1	1	1	110		1			1	30		90				1	2							30		34				16.22	20		20																																			20			20								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3572	1	0	1	1	1	H3572_001_0	3	Preferred Brand	4	11	1	1	2	1	110		1			1	30		90				1	2							30		34				97.42	15		15																																			15			15								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3572	1	0	1	1	1	H3572_001_0	3	Non-Preferred Brand	4	10	1	1	3	1	110		1			1	30		90				1	1							30		34				41.54	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3572	1	0	1	1	1	H3572_001_0	3	Specialty Tier	4	10	1	1	4	1	110		1			1	30		90				1	1							30		34				561.61	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3572	1	0	1	1	1	H3572_001_0	3	Select Care Drugs	4	1	1	1	5	1	110		1			1	30		90				1	2							30		34				0	0		0																																			0			0								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3572	1	0	1	1	1	H3572_001_0	3	Select Care Drugs	4	1	1	1	5	3	110		1			1	30		90				1	2							30		34				0	0		0																																			0			0								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3597	1	0	1	1	1	H3597_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	1	0	1	1	1	H3597_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3597	1	0	1	1	1	H3597_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	1	0	1	1	1	H3597_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3597	1	0	1	1	1	H3597_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	1	0	1	1	1	H3597_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	1	0	1	1	1	H3597_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											950.5	33						942.93	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	7	0	1	1	1	H3597_007_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	7	0	1	1	1	H3597_007_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3597	7	0	1	1	1	H3597_007_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	7	0	1	1	1	H3597_007_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3597	7	0	1	1	1	H3597_007_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	7	0	1	1	1	H3597_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	7	0	1	1	1	H3597_007_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											777.52	33						736.85	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	9	0	1	1	1	H3597_009_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	9	0	1	1	1	H3597_009_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3597	9	0	1	1	1	H3597_009_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	9	0	1	1	1	H3597_009_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3597	9	0	1	1	1	H3597_009_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	9	0	1	1	1	H3597_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3597	9	0	1	1	1	H3597_009_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											792.83	30						734.91	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3632	1	0	1	4	1	H3632_001_0	11	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3632	1	0	1	4	1	H3632_001_0	11	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3632	1	0	1	4	1	H3632_001_0	11	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		141							131																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3632	1	0	1	4	1	H3632_001_0	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											81.18	50		50				87.63	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3632	1	0	1	4	1	H3632_001_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	4	0	1	1	1	H3653_004_0	5	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	4	0	1	1	1	H3653_004_0	5	Preferred Generic	4	11	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3653	4	0	1	1	1	H3653_004_0	5	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	15		45																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	4	0	1	1	1	H3653_004_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	4	0	1	1	1	H3653_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	4	0	1	1	1	H3653_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				732.16	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	15	0	1	1	1	H3653_015_0	5	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	15	0	1	1	1	H3653_015_0	5	Preferred Generic	4	11	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3653	15	0	1	1	1	H3653_015_0	5	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	20		60																			20		40																20				20		0.66			0.66			0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	15	0	1	1	1	H3653_015_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	15	0	1	1	1	H3653_015_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	15	0	1	1	1	H3653_015_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				917.16	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	22	0	1	1	1	H3653_022_0	5	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	22	0	1	1	1	H3653_022_0	5	Preferred Generic	4	11	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3653	22	0	1	1	1	H3653_022_0	5	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	22	0	1	1	1	H3653_022_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	22	0	1	1	1	H3653_022_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	22	0	1	1	1	H3653_022_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				917.44	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	23	0	1	1	1	H3653_023_0	5	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	23	0	1	1	1	H3653_023_0	5	Preferred Generic	4	11	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3653	23	0	1	1	1	H3653_023_0	5	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	23	0	1	1	1	H3653_023_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	23	0	1	1	1	H3653_023_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	23	0	1	1	1	H3653_023_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				927.63	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	24	0	1	1	1	H3653_024_0	5	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	24	0	1	1	1	H3653_024_0	5	Preferred Generic	4	11	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3653	24	0	1	1	1	H3653_024_0	5	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	24	0	1	1	1	H3653_024_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	24	0	1	1	1	H3653_024_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3653	24	0	1	1	1	H3653_024_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				928.02	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3655	32	0	1	1	1	H3655_032_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	32	0	1	1	1	H3655_032_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	32	0	1	1	1	H3655_032_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	32	0	1	1	1	H3655_032_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	32	0	1	1	1	H3655_032_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	32	0	1	1	1	H3655_032_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	32	0	1	1	1	H3655_032_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	33	0	1	1	1	H3655_033_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	33	0	1	1	1	H3655_033_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	33	0	1	1	1	H3655_033_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	33	0	1	1	1	H3655_033_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	33	0	1	1	1	H3655_033_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	33	0	1	1	1	H3655_033_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	33	0	1	1	1	H3655_033_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	33	0	1	1	1	H3655_033_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	33	0	1	1	1	H3655_033_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	34	0	1	1	1	H3655_034_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	34	0	1	1	1	H3655_034_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	34	0	1	1	1	H3655_034_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	34	0	1	1	1	H3655_034_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	34	0	1	1	1	H3655_034_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	34	0	1	1	1	H3655_034_0	5	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	34	0	1	1	1	H3655_034_0	5	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	38	0	1	1	1	H3655_038_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					0	0	0																7				7			0.23	0.07	0			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	38	0	1	1	1	H3655_038_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	24	24																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	38	0	1	1	1	H3655_038_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	38	0	1	1	1	H3655_038_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	38	0	1	1	1	H3655_038_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	38	0	1	1	1	H3655_038_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	38	0	1	1	1	H3655_038_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	40	0	1	1	1	H3655_040_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	40	0	1	1	1	H3655_040_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	40	0	1	1	1	H3655_040_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	40	0	1	1	1	H3655_040_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	40	0	1	1	1	H3655_040_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	40	0	1	1	1	H3655_040_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	40	0	1	1	1	H3655_040_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	41	0	1	1	1	H3655_041_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	41	0	1	1	1	H3655_041_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3655	41	0	1	1	1	H3655_041_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					7	14	21					7	21	21																7				7			0.23	0.23	0.23			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	41	0	1	1	1	H3655_041_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	41	0	1	1	1	H3655_041_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	41	0	1	1	1	H3655_041_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	41	0	1	1	1	H3655_041_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3655	41	0	1	1	1	H3655_041_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3660	28	0	1	2	1	H3660_028_0	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	28	0	1	2	1	H3660_028_0	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	28	0	1	2	1	H3660_028_0	6	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		20																					20																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	28	0	1	2	1	H3660_028_0	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	39		97.5																					97.5																39				39		1.3						1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	28	0	1	2	1	H3660_028_0	6	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		285																					285																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	28	0	1	2	1	H3660_028_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	28	0	1	2	1	H3660_028_0	6	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	28	0	1	2	1	H3660_028_0	6	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	29	0	1	2	1	H3660_029_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	29	0	1	2	1	H3660_029_0	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	29	0	1	2	1	H3660_029_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		20																					20																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	29	0	1	2	1	H3660_029_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	44		110																					110																44				44		1.47						1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	29	0	1	2	1	H3660_029_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	29	0	1	2	1	H3660_029_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	29	0	1	2	1	H3660_029_0	5	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	29	0	1	2	1	H3660_029_0	5	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	44	0	1	1	1	H3660_044_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	44	0	1	1	1	H3660_044_0	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	44	0	1	1	1	H3660_044_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		20																					20																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	44	0	1	1	1	H3660_044_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	44		110																					110																44				44		1.47						1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	44	0	1	1	1	H3660_044_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	44	0	1	1	1	H3660_044_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	44	0	1	1	1	H3660_044_0	5	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	44	0	1	1	1	H3660_044_0	5	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	47	0	1	1	1	H3660_047_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		5																					5																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	47	0	1	1	1	H3660_047_0	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	2		5																					5																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	47	0	1	1	1	H3660_047_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		37.5																					37.5																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	47	0	1	1	1	H3660_047_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		117.5																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	47	0	1	1	1	H3660_047_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	47	0	1	1	1	H3660_047_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	47	0	1	1	1	H3660_047_0	5	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	47	0	1	1	1	H3660_047_0	5	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	48	0	1	2	1	H3660_048_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	48	0	1	2	1	H3660_048_0	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	48	0	1	2	1	H3660_048_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		25																					25																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	48	0	1	2	1	H3660_048_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		117.5																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	48	0	1	2	1	H3660_048_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	48	0	1	2	1	H3660_048_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	48	0	1	2	1	H3660_048_0	5	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	48	0	1	2	1	H3660_048_0	5	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	50	0	1	1	1	H3660_050_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	50	0	1	1	1	H3660_050_0	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	50	0	1	1	1	H3660_050_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		25																					25																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	50	0	1	1	1	H3660_050_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		117.5																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	50	0	1	1	1	H3660_050_0	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	50	0	1	1	1	H3660_050_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	50	0	1	1	1	H3660_050_0	5	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	50	0	1	1	1	H3660_050_0	5	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	53	1	1	1	1	H3660_053_1	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	1	1	1	1	H3660_053_1	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	53	1	1	1	1	H3660_053_1	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		20																					20																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	1	1	1	1	H3660_053_1	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	44		110																					110																44				44		1.47						1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	1	1	1	1	H3660_053_1	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	1	1	1	1	H3660_053_1	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	1	1	1	1	H3660_053_1	5	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	1	1	1	1	H3660_053_1	5	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	53	2	1	1	1	H3660_053_2	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	2	1	1	1	H3660_053_2	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3660	53	2	1	1	1	H3660_053_2	5	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		20																					20																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	2	1	1	1	H3660_053_2	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	44		110																					110																44				44		1.47						1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	2	1	1	1	H3660_053_2	5	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	2	1	1	1	H3660_053_2	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	2	1	1	1	H3660_053_2	5	Vaccines	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3660	53	2	1	1	1	H3660_053_2	5	Vaccines	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3664	17	0	1	2	1	H3664_017_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				0			0.33	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	17	0	1	2	1	H3664_017_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					6	12	18					6	12	15																16				6			0.53	0.2	0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	17	0	1	2	1	H3664_017_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					45	90	125																47				42			1.57	1.4	1.5			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	17	0	1	2	1	H3664_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	275																100				95			3.33	3.17	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	17	0	1	2	1	H3664_017_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											895.62	31						895.62	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	20	0	1	2	1	H3664_020_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					2	4	6																10				0			0.33	0	0.07			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	20	0	1	2	1	H3664_020_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					8	16	24					8	16	20																18				8			0.6	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	20	0	1	2	1	H3664_020_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					45	90	125																47				42			1.57	1.4	1.5			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	20	0	1	2	1	H3664_020_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	275																100				95			3.33	3.17	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	20	0	1	2	1	H3664_020_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1266.97	30						1266.97	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	21	0	1	2	1	H3664_021_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					3	6	9																10				0			0.33	0	0.1			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	21	0	1	2	1	H3664_021_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	45																20				15			0.67	0.5	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	21	0	1	2	1	H3664_021_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					45	90	135																47				42			1.57	1.4	1.5			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	21	0	1	2	1	H3664_021_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				95			3.33	3.17	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3664	21	0	1	2	1	H3664_021_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											937.62	29						937.62	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	14	0	1	1	1	H3668_014_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	14	0	1	1	1	H3668_014_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	14	0	1	1	1	H3668_014_0	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	14	0	1	1	1	H3668_014_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	14	0	1	1	1	H3668_014_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	14	0	1	1	1	H3668_014_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	15	0	1	1	1	H3668_015_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	15	0	1	1	1	H3668_015_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	15	0	1	1	1	H3668_015_0	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	18	36	54																			18	36	36																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	15	0	1	1	1	H3668_015_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	15	0	1	1	1	H3668_015_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	15	0	1	1	1	H3668_015_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	16	0	1	1	1	H3668_016_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	16	0	1	1	1	H3668_016_0	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	16	0	1	1	1	H3668_016_0	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	16	0	1	1	1	H3668_016_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	16	0	1	1	1	H3668_016_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	16	0	1	1	1	H3668_016_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	17	0	1	1	1	H3668_017_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	17	0	1	1	1	H3668_017_0	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	17	0	1	1	1	H3668_017_0	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	17	0	1	1	1	H3668_017_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	17	0	1	1	1	H3668_017_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	17	0	1	1	1	H3668_017_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	1	1	1	1	H3668_018_1	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	1	1	1	1	H3668_018_1	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	18	1	1	1	1	H3668_018_1	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	1	1	1	1	H3668_018_1	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	1	1	1	1	H3668_018_1	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	1	1	1	1	H3668_018_1	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	2	1	1	1	H3668_018_2	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	2	1	1	1	H3668_018_2	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	18	2	1	1	1	H3668_018_2	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	2	1	1	1	H3668_018_2	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	2	1	1	1	H3668_018_2	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	2	1	1	1	H3668_018_2	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	3	1	1	1	H3668_018_3	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	3	1	1	1	H3668_018_3	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	18	3	1	1	1	H3668_018_3	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	3	1	1	1	H3668_018_3	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	3	1	1	1	H3668_018_3	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	18	3	1	1	1	H3668_018_3	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	1	1	1	1	H3668_019_1	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	1	1	1	1	H3668_019_1	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	19	1	1	1	1	H3668_019_1	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	1	1	1	1	H3668_019_1	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	1	1	1	1	H3668_019_1	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	1	1	1	1	H3668_019_1	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	2	1	1	1	H3668_019_2	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	2	1	1	1	H3668_019_2	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	19	2	1	1	1	H3668_019_2	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	2	1	1	1	H3668_019_2	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	2	1	1	1	H3668_019_2	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	2	1	1	1	H3668_019_2	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	3	1	1	1	H3668_019_3	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	3	1	1	1	H3668_019_3	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	2	4	6																			0	0	0																2				2		0.07			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	19	3	1	1	1	H3668_019_3	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	3	1	1	1	H3668_019_3	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	3	1	1	1	H3668_019_3	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	19	3	1	1	1	H3668_019_3	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	20	0	1	1	1	H3668_020_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	20	0	1	1	1	H3668_020_0	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	20	0	1	1	1	H3668_020_0	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	20	0	1	1	1	H3668_020_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	20	0	1	1	1	H3668_020_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	20	0	1	1	1	H3668_020_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	21	0	1	1	1	H3668_021_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	21	0	1	1	1	H3668_021_0	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	21	0	1	1	1	H3668_021_0	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			0	0	0																5				5		0.17			0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	21	0	1	1	1	H3668_021_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	21	0	1	1	1	H3668_021_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	21	0	1	1	1	H3668_021_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	22	0	1	1	1	H3668_022_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	22	0	1	1	1	H3668_022_0	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	22	0	1	1	1	H3668_022_0	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			0	0	0																10				10		0.33			0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	22	0	1	1	1	H3668_022_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	22	0	1	1	1	H3668_022_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	22	0	1	1	1	H3668_022_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	23	0	1	1	1	H3668_023_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	23	0	1	1	1	H3668_023_0	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	23	0	1	1	1	H3668_023_0	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			0	0	0																10				10		0.33			0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	23	0	1	1	1	H3668_023_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	23	0	1	1	1	H3668_023_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	23	0	1	1	1	H3668_023_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	24	0	1	1	1	H3668_024_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	24	0	1	1	1	H3668_024_0	6	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3668	24	0	1	1	1	H3668_024_0	6	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			0	0	0																10				10		0.33			0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	24	0	1	1	1	H3668_024_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	24	0	1	1	1	H3668_024_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	75	150	225																			75	150	150																75				75		2.5			2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3668	24	0	1	1	1	H3668_024_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	13	0	1	1	1	H3672_013_0	5	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								13		39					3		9							0																13				13			0.43	0.1				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	13	0	1	1	1	H3672_013_0	5	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	13	0	1	1	1	H3672_013_0	5	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	13	0	1	1	1	H3672_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	13	0	1	1	1	H3672_013_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	31						1000	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	18	0	1	1	1	H3672_018_0	6	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								15		45					5		15							0																15				15			0.5	0.17				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	18	0	1	1	1	H3672_018_0	6	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	18	0	1	1	1	H3672_018_0	6	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	18	0	1	1	1	H3672_018_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	18	0	1	1	1	H3672_018_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	30						1000	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	20	0	1	1	1	H3672_020_0	5	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								13		39					3		9							0																13				13			0.43	0.1				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	20	0	1	1	1	H3672_020_0	5	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	20	0	1	1	1	H3672_020_0	5	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	20	0	1	1	1	H3672_020_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	20	0	1	1	1	H3672_020_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	31						1000	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	23	0	1	1	1	H3672_023_0	5	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								13		39					3		9							0																13				13			0.43	0.1				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	23	0	1	1	1	H3672_023_0	5	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	23	0	1	1	1	H3672_023_0	5	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	23	0	1	1	1	H3672_023_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	23	0	1	1	1	H3672_023_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	31						1000	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	25	0	1	1	1	H3672_025_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								13		39					3		9							0																13				13			0.43	0.1				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	25	0	1	1	1	H3672_025_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	25	0	1	1	1	H3672_025_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	25	0	1	1	1	H3672_025_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3672	25	0	1	1	1	H3672_025_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	31						1000	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	1	0	1	1	1	H3706_001_0	7	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	1				30		90	30		31								10		30					5		0											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	1	0	1	1	1	H3706_001_0	7	Preferred Generic	4	11	1	2	1	3		110	1		110	1				30		90	1	1				30		90	30		31								10		30					5		0											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3706	1	0	1	1	1	H3706_001_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	1				30		90	30		31								20		60					15		0											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	1	0	1	1	1	H3706_001_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	1				30		90	30		31								47		141					42		84											47		141				42		84				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	1	0	1	1	1	H3706_001_0	7	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	1	1				30		90	30		31								47		141					42		84											47		141				42		84				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H3706	1	0	1	1	1	H3706_001_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	1				30		90	30		31											59.23	50		50				46.34	40		40										50		50				40		40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	1	0	1	1	1	H3706_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	18	0	1	1	1	H3706_018_0	9	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	1				30		90	30		31								8		24					3		0											8		24				3		0				8				8			0.27	0.1		0.27	0.1	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	18	0	1	1	1	H3706_018_0	9	Preferred Generic	4	11	1	2	1	3		110	1		110	1				30		90	1	1				30		90	30		31								8		24					3		0											8		24				3		0				8				8			0.27	0.1		0.27	0.1	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3706	18	0	1	1	1	H3706_018_0	9	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	1				30		90	30		31								18		54					13		0											18		54				13		0				18				18			0.6	0.43		0.6	0.43	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	18	0	1	1	1	H3706_018_0	9	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	1				30		90	30		31								45		135					40		80											45		135				40		80				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	18	0	1	1	1	H3706_018_0	9	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	1	1				30		90	30		31								45		135					40		80											45		135				40		80				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H3706	18	0	1	1	1	H3706_018_0	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	1				30		90	30		31											80.72	50		50				64.22	40		40										50		50				40		40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3706	18	0	1	1	1	H3706_018_0	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3725	1	0	1	4	1	H3725_001_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3725	1	0	1	4	1	H3725_001_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3725	1	0	1	4	1	H3725_001_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3725	1	0	1	4	1	H3725_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3725	1	0	1	4	1	H3725_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											774.68	33						774.68	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3725	1	0	1	4	1	H3725_001_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3725	1	0	1	4	1	H3725_001_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3748	1	0	1	1	1	H3748_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	1	0	1	1	1	H3748_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	1	0	1	1	1	H3748_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	1	0	1	1	1	H3748_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	1	0	1	1	1	H3748_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	1	0	1	1	1	H3748_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	1	0	1	1	1	H3748_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.57	33						715.83	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	2	0	1	1	1	H3748_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	2	0	1	1	1	H3748_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	2	0	1	1	1	H3748_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	2	0	1	1	1	H3748_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	2	0	1	1	1	H3748_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	2	0	1	1	1	H3748_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	2	0	1	1	1	H3748_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.58	33						715.81	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	3	0	1	1	1	H3748_003_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	3	0	1	1	1	H3748_003_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	3	0	1	1	1	H3748_003_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	3	0	1	1	1	H3748_003_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	3	0	1	1	1	H3748_003_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	3	0	1	1	1	H3748_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	3	0	1	1	1	H3748_003_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.54	33						715.83	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	4	0	1	1	1	H3748_004_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	4	0	1	1	1	H3748_004_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	4	0	1	1	1	H3748_004_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	4	0	1	1	1	H3748_004_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3748	4	0	1	1	1	H3748_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	4	0	1	1	1	H3748_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3748	4	0	1	1	1	H3748_004_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.56	33						715.81	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3749	1	0	1	2	1	H3749_001_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	1	0	1	2	1	H3749_001_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	1	0	1	2	1	H3749_001_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	1	0	1	2	1	H3749_001_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	1	0	1	2	1	H3749_001_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				902	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	17	0	1	2	1	H3749_017_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	17	0	1	2	1	H3749_017_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	17	0	1	2	1	H3749_017_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	17	0	1	2	1	H3749_017_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	17	0	1	2	1	H3749_017_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				834	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	18	0	1	2	1	H3749_018_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	18	0	1	2	1	H3749_018_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	18	0	1	2	1	H3749_018_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	18	0	1	2	1	H3749_018_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	18	0	1	2	1	H3749_018_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				858	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	20	0	1	2	1	H3749_020_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	20	0	1	2	1	H3749_020_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	20	0	1	2	1	H3749_020_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	20	0	1	2	1	H3749_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3749	20	0	1	2	1	H3749_020_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				766	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	1	0	1	1	1	H3755_001_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	1	0	1	1	1	H3755_001_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3755	1	0	1	1	1	H3755_001_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	1	0	1	1	1	H3755_001_0	6	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3755	1	0	1	1	1	H3755_001_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	1	0	1	1	1	H3755_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	1	0	1	1	1	H3755_001_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				2268.17	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	4	0	1	1	1	H3755_004_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	4	0	1	1	1	H3755_004_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3755	4	0	1	1	1	H3755_004_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	4	0	1	1	1	H3755_004_0	6	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3755	4	0	1	1	1	H3755_004_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	4	0	1	1	1	H3755_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	4	0	1	1	1	H3755_004_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				2066.1	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	5	0	1	1	1	H3755_005_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	5	0	1	1	1	H3755_005_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3755	5	0	1	1	1	H3755_005_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	13	26	39																			13	26	26																13				13		0.43			0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	5	0	1	1	1	H3755_005_0	6	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	13	26	39																			13	26	26																13				13		0.43			0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3755	5	0	1	1	1	H3755_005_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	5	0	1	1	1	H3755_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	90	180	270																			90	180	180																90				90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3755	5	0	1	1	1	H3755_005_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				2009.25	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3777	1	2	1	1	1	H3777_001_2	14	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	2	1	1	1	H3777_001_2	14	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		12.5																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	2	1	1	1	H3777_001_2	14	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	2	1	1	1	H3777_001_2	14	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	99		297																			99		247.5																99				99		3.3			3.3			3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	2	1	1	1	H3777_001_2	14	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				918.72	30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	2	1	1	1	H3777_001_2	14	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	2	1	1	1	H3777_001_2	14	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3777	1	3	1	1	1	H3777_001_3	14	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	3	1	1	1	H3777_001_3	14	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		12.5																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	3	1	1	1	H3777_001_3	14	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	3	1	1	1	H3777_001_3	14	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	99		297																			99		247.5																99				99		3.3			3.3			3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	3	1	1	1	H3777_001_3	14	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				918.72	30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	3	1	1	1	H3777_001_3	14	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	3	1	1	1	H3777_001_3	14	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3777	1	4	1	1	1	H3777_001_4	14	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	4	1	1	1	H3777_001_4	14	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		12.5																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	4	1	1	1	H3777_001_4	14	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	4	1	1	1	H3777_001_4	14	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	99		297																			99		247.5																99				99		3.3			3.3			3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	4	1	1	1	H3777_001_4	14	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				918.72	30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	4	1	1	1	H3777_001_4	14	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3777	1	4	1	1	1	H3777_001_4	14	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3805	1	0	1	1	1	H3805_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	1	0	1	1	1	H3805_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	1	0	1	1	1	H3805_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	1	0	1	1	1	H3805_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	1	0	1	1	1	H3805_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1143	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	7	0	1	1	1	H3805_007_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	7	0	1	1	1	H3805_007_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	7	0	1	1	1	H3805_007_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	7	0	1	1	1	H3805_007_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	7	0	1	1	1	H3805_007_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1419	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	15	0	1	1	1	H3805_015_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	15	0	1	1	1	H3805_015_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	15	0	1	1	1	H3805_015_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	15	0	1	1	1	H3805_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	15	0	1	1	1	H3805_015_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				975	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	16	0	1	1	1	H3805_016_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	16	0	1	1	1	H3805_016_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	16	0	1	1	1	H3805_016_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	16	0	1	1	1	H3805_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	16	0	1	1	1	H3805_016_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				913	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	17	0	1	1	1	H3805_017_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	17	0	1	1	1	H3805_017_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	17	0	1	1	1	H3805_017_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	17	0	1	1	1	H3805_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	17	0	1	1	1	H3805_017_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				784	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	19	0	1	1	1	H3805_019_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	19	0	1	1	1	H3805_019_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	19	0	1	1	1	H3805_019_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	19	0	1	1	1	H3805_019_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	19	0	1	1	1	H3805_019_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				883	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	20	0	1	1	1	H3805_020_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	20	0	1	1	1	H3805_020_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	20	0	1	1	1	H3805_020_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	20	0	1	1	1	H3805_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	20	0	1	1	1	H3805_020_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				823	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	21	0	1	1	1	H3805_021_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	21	0	1	1	1	H3805_021_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	21	0	1	1	1	H3805_021_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	21	0	1	1	1	H3805_021_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	21	0	1	1	1	H3805_021_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1018	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	1	1	1	1	H3805_022_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	1	1	1	1	H3805_022_1	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						24				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	1	1	1	1	H3805_022_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	1	1	1	1	H3805_022_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	1	1	1	1	H3805_022_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				998	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	2	1	1	1	H3805_022_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	2	1	1	1	H3805_022_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						24				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	2	1	1	1	H3805_022_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	2	1	1	1	H3805_022_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	22	2	1	1	1	H3805_022_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				998	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	1	1	1	1	H3805_023_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	1	1	1	1	H3805_023_1	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						24				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	1	1	1	1	H3805_023_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	1	1	1	1	H3805_023_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	1	1	1	1	H3805_023_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				795	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	2	1	1	1	H3805_023_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	2	1	1	1	H3805_023_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						24				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	2	1	1	1	H3805_023_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	2	1	1	1	H3805_023_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	23	2	1	1	1	H3805_023_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				795	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	1	1	1	1	H3805_024_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	1	1	1	1	H3805_024_1	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	1	1	1	1	H3805_024_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	1	1	1	1	H3805_024_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	1	1	1	1	H3805_024_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				875	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	2	1	1	1	H3805_024_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	2	1	1	1	H3805_024_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	2	1	1	1	H3805_024_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	2	1	1	1	H3805_024_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	2	1	1	1	H3805_024_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				875	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	3	1	1	1	H3805_024_3	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	3	1	1	1	H3805_024_3	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	3	1	1	1	H3805_024_3	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	3	1	1	1	H3805_024_3	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	24	3	1	1	1	H3805_024_3	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				875	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	1	1	1	1	H3805_025_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	1	1	1	1	H3805_025_1	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	1	1	1	1	H3805_025_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	1	1	1	1	H3805_025_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	1	1	1	1	H3805_025_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1001	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	2	1	1	1	H3805_025_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	2	1	1	1	H3805_025_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	2	1	1	1	H3805_025_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	2	1	1	1	H3805_025_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	25	2	1	1	1	H3805_025_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1001	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	29	0	1	1	1	H3805_029_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	29	0	1	1	1	H3805_029_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						12				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	29	0	1	1	1	H3805_029_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	29	0	1	1	1	H3805_029_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	29	0	1	1	1	H3805_029_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				851	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	30	0	1	1	1	H3805_030_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	30	0	1	1	1	H3805_030_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	30	0	1	1	1	H3805_030_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	30	0	1	1	1	H3805_030_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	30	0	1	1	1	H3805_030_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											911	30		30				726	30		30												30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	32	0	1	1	1	H3805_032_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	32	0	1	1	1	H3805_032_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	32	0	1	1	1	H3805_032_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	32	0	1	1	1	H3805_032_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3805	32	0	1	1	1	H3805_032_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											857	29		29				762	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3810	3	0	1	1	1	H3810_003_0	7	Preferred Generic	4	1	3	2	1	1	111		1		100	1	30	60	90				1	2						90	30		31	5	10	0																											15						0				5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	3	0	1	1	1	H3810_003_0	7	Preferred Generic	4	1	3	2	1	3	111		1		100	1	30	60	90				1	2						90	30		31	10	20	0																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H3810	3	0	1	1	1	H3810_003_0	7	Generic	4	1	1	2	2	1	111		1		100	1	30	60	90				1	2						90	30		31	15	30	30																											45						30				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	3	0	1	1	1	H3810_003_0	7	Preferred Brand	4	10	1	2	3	1	111		1		100	1	30	60	90				1	2						90	30		31	47	94	94																											141						94				47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	3	0	1	1	1	H3810_003_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1		100	1	30	60	90				1	2						90	30		31	98	196	196																											294						196				98				98		3.27						3.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	3	0	1	1	1	H3810_003_0	7	Specialty Tier	4	11	1	1	5	1	111		1		100	1	30	60	90				1	2						90	30		31				0	29	29	29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	3	0	1	1	1	H3810_003_0	7	Select Care Drugs	4	11	1	2	6	1	111		1		100	1	30	60	90				1	2						90	30		31	0	0	0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	3	0	1	1	1	H3810_003_0	7	Select Care Drugs	4	11	1	2	6	3	111		1		100	1	30	60	90				1	2						90	30		31	0	0	0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3810	22	0	1	1	1	H3810_022_0	7	Preferred Generic	4	1	3	2	1	1	111		1		100	1	30	60	90				1	2						90	30		31	5	10	0																											15						0				5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	22	0	1	1	1	H3810_022_0	7	Preferred Generic	4	1	3	2	1	3	111		1		100	1	30	60	90				1	2						90	30		31	10	20	0																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H3810	22	0	1	1	1	H3810_022_0	7	Generic	4	1	1	2	2	1	111		1		100	1	30	60	90				1	2						90	30		31	15	30	45																											45						45				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	22	0	1	1	1	H3810_022_0	7	Preferred Brand	4	10	1	2	3	1	111		1		100	1	30	60	90				1	2						90	30		31	47	94	141																											141						141				47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	22	0	1	1	1	H3810_022_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1		100	1	30	60	90				1	2						90	30		31	100	200	300																											300						300				100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	22	0	1	1	1	H3810_022_0	7	Specialty Tier	4	11	1	1	5	1	111		1		100	1	30	60	90				1	2						90	30		31				0	27	27	27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	22	0	1	1	1	H3810_022_0	7	Select Care Drugs	4	11	1	2	6	1	111		1		100	1	30	60	90				1	2						90	30		31	0	0	0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3810	22	0	1	1	1	H3810_022_0	7	Select Care Drugs	4	11	1	2	6	3	111		1		100	1	30	60	90				1	2						90	30		31	0	0	0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3811	2	0	1	1	1	H3811_002_0	6	Preferred Generic	4	11	1	2	1	1	111		1	100		1	34	60	90				1	2			90				34		31	3	6	9																					9																3				3		0.09						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	2	0	1	1	1	H3811_002_0	6	Generic	4	11	1	2	2	1	111		1	100		1	34	60	90				1	2			90				34		31	9	18	27																					27																9				9		0.26						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	2	0	1	1	1	H3811_002_0	6	Preferred Brand	4	11	1	2	3	1	111		1	100		1	34	60	90				1	2			90				34		31	47	94	141																					141																47				47		1.38						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	2	0	1	1	1	H3811_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	34	60	90				1	2			90				34		31				58.14	46	46	46																				46															46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	2	0	1	1	1	H3811_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	34														34		31				579.59	29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	2	0	1	1	1	H3811_002_0	6	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	34	60	90				1	2			90				34		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	9	0	1	1	1	H3811_009_0	6	Preferred Generic	4	11	1	2	1	1	111		1	100		1	34	60	90				1	2			90				34		31	3	6	9																					9																3				3		0.09						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	9	0	1	1	1	H3811_009_0	6	Preferred Generic	4	11	1	2	1	3	111		1	100		1	34	60	90				1	2			90				34		31	3	6	9																					9																3				3		0.09						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3811	9	0	1	1	1	H3811_009_0	6	Generic	4	11	1	2	2	1	111		1	100		1	34	60	90				1	2			90				34		31	9	18	27																					27																9				9		0.26						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	9	0	1	1	1	H3811_009_0	6	Generic	4	11	1	2	2	3	111		1	100		1	34	60	90				1	2			90				34		31	9	18	27																					27																9				9		0.26						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3811	9	0	1	1	1	H3811_009_0	6	Preferred Brand	4	11	1	2	3	1	111		1	100		1	34	60	90				1	2			90				34		31	47	94	141																					141																47				47		1.38						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	9	0	1	1	1	H3811_009_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	34	60	90				1	2			90				34		31				62.68	50	50	50																				50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	9	0	1	1	1	H3811_009_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	34														34		31				612.49	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	9	0	1	1	1	H3811_009_0	6	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	34	60	90				1	2			90				34		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3811	9	0	1	1	1	H3811_009_0	6	Select Care Drugs	4	11	1	2	6	3	111		1	100		1	34	60	90				1	2			90				34		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3813	6	0	1	4	1	H3813_006_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	5	10	15																			5	10	15																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	6	0	1	4	1	H3813_006_0	6	Generic	4	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	15	30	45																			15	30	45																15				15		0.48			0.48			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	6	0	1	4	1	H3813_006_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	47	94	141																			47	94	141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	6	0	1	4	1	H3813_006_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	100	200	300																			100	200	300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	6	0	1	4	1	H3813_006_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				300	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	6	0	1	4	1	H3813_006_0	6	Vaccines	4	11	1	2	6	1	10		1	10		1	31								31						31		31	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	7	0	1	4	1	H3813_007_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	2	4	6																			2	4	6																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	7	0	1	4	1	H3813_007_0	6	Generic	4	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	20	40	60																			20	40	60																20				20		0.65			0.65			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	7	0	1	4	1	H3813_007_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	45	90	135																			45	90	135																45				45		1.45			1.45			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	7	0	1	4	1	H3813_007_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	100	200	300																			100	200	300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	7	0	1	4	1	H3813_007_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				300	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	7	0	1	4	1	H3813_007_0	6	Vaccines	4	11	1	2	6	1	10		1	10		1	31								31						31		31	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	9	0	1	4	1	H3813_009_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	2	4	6																			2	4	6																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	9	0	1	4	1	H3813_009_0	6	Generic	4	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	20	40	60																			20	40	60																20				20		0.65			0.65			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	9	0	1	4	1	H3813_009_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	45	90	135																			45	90	135																45				45		1.45			1.45			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	9	0	1	4	1	H3813_009_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		31	100	200	300																			100	200	300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	9	0	1	4	1	H3813_009_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				300	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	9	0	1	4	1	H3813_009_0	6	Vaccines	4	11	1	2	6	1	10		1	10		1	31								31						31		31	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	10	0	1	4	1	H3813_010_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	12																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	10	0	1	4	1	H3813_010_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	10	0	1	4	1	H3813_010_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	10	0	1	4	1	H3813_010_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	10	0	1	4	1	H3813_010_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				300	29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	10	0	1	4	1	H3813_010_0	6	Vaccines	4	11	1	2	6	1	10		1	10		1	30								30						30		31	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	11	0	1	4	1	H3813_011_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	15																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	11	0	1	4	1	H3813_011_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	11	0	1	4	1	H3813_011_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	11	0	1	4	1	H3813_011_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	11	0	1	4	1	H3813_011_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				300	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	11	0	1	4	1	H3813_011_0	6	Vaccines	4	11	1	2	6	1	10		1	10		1	30								30						30		31	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	12	0	1	4	1	H3813_012_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	8	12																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	12	0	1	4	1	H3813_012_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	12	0	1	4	1	H3813_012_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	12	0	1	4	1	H3813_012_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	12	0	1	4	1	H3813_012_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				300	29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	12	0	1	4	1	H3813_012_0	6	Vaccines	4	11	1	2	6	1	10		1	10		1	30								30						30		31	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	13	0	1	4	1	H3813_013_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	15																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	13	0	1	4	1	H3813_013_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	13	0	1	4	1	H3813_013_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	13	0	1	4	1	H3813_013_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	13	0	1	4	1	H3813_013_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				300	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3813	13	0	1	4	1	H3813_013_0	6	Vaccines	4	11	1	2	6	1	10		1	10		1	30								30						30		31	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3815	1	0	1	1	1	H3815_001_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	1	0	1	1	1	H3815_001_0	4	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	1	0	1	1	1	H3815_001_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	12.5																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	1	0	1	1	1	H3815_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37	67	97					30	60	90					30	60	75																	37			30			1.23	1	1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	1	0	1	1	1	H3815_001_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	1	0	1	1	1	H3815_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	1	0	1	1	1	H3815_001_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3	6	0					3	6	0					3	6	0																	3			3			0.1	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	1	0	1	1	1	H3815_001_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3	6	0					3	6	0					3	6	0																	3			3			0.1	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	6	0	1	1	1	H3815_006_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	12.5																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	6	0	1	1	1	H3815_006_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17	27	37					10	20	30					10	20	25																	17			10			0.57	0.33	0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	6	0	1	1	1	H3815_006_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	100																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	6	0	1	1	1	H3815_006_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	193	286					93	186	279					93	186	232.5																	100			93			3.33	3.1	3.1			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	6	0	1	1	1	H3815_006_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											2157	33						2157	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	6	0	1	1	1	H3815_006_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	6	0	1	1	1	H3815_006_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	7	0	1	1	1	H3815_007_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	7	0	1	1	1	H3815_007_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	7	0	1	1	1	H3815_007_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	7	0	1	1	1	H3815_007_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	7	0	1	1	1	H3815_007_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1553	33						1553	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	7	0	1	1	1	H3815_007_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	7	0	1	1	1	H3815_007_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	8	0	1	1	1	H3815_008_0	5	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	8	0	1	1	1	H3815_008_0	5	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	8	0	1	1	1	H3815_008_0	5	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10	13	16					3	6	9					3	6	7.5																	10			3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	8	0	1	1	1	H3815_008_0	5	Generic	4	1	3	2	2	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10	13	16					3	6	9					3	6	7.5																	10			3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H3815	8	0	1	1	1	H3815_008_0	5	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37	67	97					30	60	90					30	60	75																	37			30			1.23	1	1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	8	0	1	1	1	H3815_008_0	5	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82	157	232					75	150	225					75	150	187.5																	82			75			2.73	2.5	2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	8	0	1	1	1	H3815_008_0	5	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1379	33						1379	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	8	0	1	1	1	H3815_008_0	5	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	8	0	1	1	1	H3815_008_0	5	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	9	0	1	1	1	H3815_009_0	5	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								0	0	0					0	0	0					0	0	0																	0			0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	9	0	1	1	1	H3815_009_0	5	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								20	40	60					14	28	42					14	28	42																	20			14			0.67	0.47	0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	9	0	1	1	1	H3815_009_0	5	Preferred Brand	4	11	1	1	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											106	25	25	25				103	25	25	25				25	25	25																25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	9	0	1	1	1	H3815_009_0	5	Non-Preferred Brand	4	11	3	1	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											154	25	25	25				126	25	25	25				25	25	25																25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	9	0	1	1	1	H3815_009_0	5	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											993	25						993	25						25																		25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	9	0	1	1	1	H3815_009_0	5	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	10	0	1	1	1	H3815_010_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	10	0	1	1	1	H3815_010_0	4	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	10	0	1	1	1	H3815_010_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	12.5																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	10	0	1	1	1	H3815_010_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37	67	97					30	60	90					30	60	75																	37			30			1.23	1	1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	10	0	1	1	1	H3815_010_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82	157	232					75	150	225					75	150	187.5																	82			75			2.73	2.5	2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	10	0	1	1	1	H3815_010_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1339	33						1339	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	10	0	1	1	1	H3815_010_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	10	0	1	1	1	H3815_010_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	11	0	1	1	1	H3815_011_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	12.5																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	11	0	1	1	1	H3815_011_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17	27	37					10	20	30					10	20	25																	17			10			0.57	0.33	0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	11	0	1	1	1	H3815_011_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	100																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	11	0	1	1	1	H3815_011_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	193	286					93	186	279					93	186	232.5																	100			93			3.33	3.1	3.1			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	11	0	1	1	1	H3815_011_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											2044	33						2044	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	11	0	1	1	1	H3815_011_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	11	0	1	1	1	H3815_011_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	13	0	1	1	1	H3815_013_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	13	0	1	1	1	H3815_013_0	4	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	13	0	1	1	1	H3815_013_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17	27	37					10	20	30					10	20	25																	17			10			0.57	0.33	0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	13	0	1	1	1	H3815_013_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37	67	97					30	60	90					30	60	75																	37			30			1.23	1	1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	13	0	1	1	1	H3815_013_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	13	0	1	1	1	H3815_013_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											336	33						336	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	13	0	1	1	1	H3815_013_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	13	0	1	1	1	H3815_013_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	15	0	1	1	1	H3815_015_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	15	0	1	1	1	H3815_015_0	4	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	15	0	1	1	1	H3815_015_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	15	0	1	1	1	H3815_015_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37	67	97					30	60	90					30	60	90																	37			30			1.23	1	1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	15	0	1	1	1	H3815_015_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	15	0	1	1	1	H3815_015_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1491	33						1491	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	15	0	1	1	1	H3815_015_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3	6	0					3	6	0					3	6	0																	3			3			0.1	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	15	0	1	1	1	H3815_015_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3	6	0					3	6	0					3	6	0																	3			3			0.1	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	16	0	1	1	1	H3815_016_0	5	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	16	0	1	1	1	H3815_016_0	5	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	16	0	1	1	1	H3815_016_0	5	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10	13	16					3	6	9					3	6	9																	10			3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	16	0	1	1	1	H3815_016_0	5	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37	67	97					30	60	90					30	60	90																	37			30			1.23	1	1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	16	0	1	1	1	H3815_016_0	5	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82	157	232					75	150	225					75	150	225																	82			75			2.73	2.5	2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	16	0	1	1	1	H3815_016_0	5	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	16	0	1	1	1	H3815_016_0	5	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	16	0	1	1	1	H3815_016_0	5	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	18	0	1	1	1	H3815_018_0	6	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	18	0	1	1	1	H3815_018_0	6	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	18	0	1	1	1	H3815_018_0	6	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10	13	16					3	6	9					3	6	9																	10			3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	18	0	1	1	1	H3815_018_0	6	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37	67	97					30	60	90					30	60	90																	37			30			1.23	1	1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	18	0	1	1	1	H3815_018_0	6	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82	157	232					75	150	225					75	150	225																	82			75			2.73	2.5	2.5			2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	18	0	1	1	1	H3815_018_0	6	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	18	0	1	1	1	H3815_018_0	6	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	18	0	1	1	1	H3815_018_0	6	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	19	0	1	1	1	H3815_019_0	3	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	19	0	1	1	1	H3815_019_0	3	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	19	0	1	1	1	H3815_019_0	3	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	19	0	1	1	1	H3815_019_0	3	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	19	0	1	1	1	H3815_019_0	3	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	19	0	1	1	1	H3815_019_0	3	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	19	0	1	1	1	H3815_019_0	3	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	20	0	1	1	1	H3815_020_0	3	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	20	0	1	1	1	H3815_020_0	3	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	20	0	1	1	1	H3815_020_0	3	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	20	0	1	1	1	H3815_020_0	3	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	20	0	1	1	1	H3815_020_0	3	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	20	0	1	1	1	H3815_020_0	3	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	20	0	1	1	1	H3815_020_0	3	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	21	0	1	1	1	H3815_021_0	3	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	21	0	1	1	1	H3815_021_0	3	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	21	0	1	1	1	H3815_021_0	3	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	21	0	1	1	1	H3815_021_0	3	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	21	0	1	1	1	H3815_021_0	3	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	21	0	1	1	1	H3815_021_0	3	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	21	0	1	1	1	H3815_021_0	3	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	22	0	1	1	1	H3815_022_0	3	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	22	0	1	1	1	H3815_022_0	3	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	22	0	1	1	1	H3815_022_0	3	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	22	0	1	1	1	H3815_022_0	3	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	22	0	1	1	1	H3815_022_0	3	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	22	0	1	1	1	H3815_022_0	3	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	22	0	1	1	1	H3815_022_0	3	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	23	0	1	1	1	H3815_023_0	3	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	23	0	1	1	1	H3815_023_0	3	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	23	0	1	1	1	H3815_023_0	3	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	23	0	1	1	1	H3815_023_0	3	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	23	0	1	1	1	H3815_023_0	3	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	23	0	1	1	1	H3815_023_0	3	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	23	0	1	1	1	H3815_023_0	3	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	24	0	1	1	1	H3815_024_0	3	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	24	0	1	1	1	H3815_024_0	3	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	24	0	1	1	1	H3815_024_0	3	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	24	0	1	1	1	H3815_024_0	3	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	24	0	1	1	1	H3815_024_0	3	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	24	0	1	1	1	H3815_024_0	3	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	24	0	1	1	1	H3815_024_0	3	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3815	25	0	1	1	1	H3815_025_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	12.5																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	25	0	1	1	1	H3815_025_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17	27	37					10	20	30					10	20	25																	17			10			0.57	0.33	0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	25	0	1	1	1	H3815_025_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	100																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	25	0	1	1	1	H3815_025_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	193	286					93	186	279					93	186	232.5																	100			93			3.33	3.1	3.1			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	25	0	1	1	1	H3815_025_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											2157	33						2157	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	25	0	1	1	1	H3815_025_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3815	25	0	1	1	1	H3815_025_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3817	8	1	1	4	1	H3817_008_1	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	1	1	4	1	H3817_008_1	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	1	1	4	1	H3817_008_1	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	1	1	4	1	H3817_008_1	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	1	1	4	1	H3817_008_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	2	1	4	1	H3817_008_2	12	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	2	1	4	1	H3817_008_2	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	2	1	4	1	H3817_008_2	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	2	1	4	1	H3817_008_2	12	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	8	2	1	4	1	H3817_008_2	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	1	1	4	1	H3817_009_1	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	1	1	4	1	H3817_009_1	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	1	1	4	1	H3817_009_1	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	1	1	4	1	H3817_009_1	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	1	1	4	1	H3817_009_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											853.32	33						853.32	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	2	1	4	1	H3817_009_2	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	2	1	4	1	H3817_009_2	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	2	1	4	1	H3817_009_2	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	2	1	4	1	H3817_009_2	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	9	2	1	4	1	H3817_009_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											853.32	33						853.32	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	1	1	4	1	H3817_011_1	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	1	1	4	1	H3817_011_1	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	1	1	4	1	H3817_011_1	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	1	1	4	1	H3817_011_1	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	1	1	4	1	H3817_011_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											698.17	27						698.17	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	2	1	4	1	H3817_011_2	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	2	1	4	1	H3817_011_2	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	2	1	4	1	H3817_011_2	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	2	1	4	1	H3817_011_2	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3817	11	2	1	4	1	H3817_011_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											698.17	27						698.17	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3822	1	0	1	1	1	H3822_001_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	1	0	1	1	1	H3822_001_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3822	1	0	1	1	1	H3822_001_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	1	0	1	1	1	H3822_001_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	1	0	1	1	1	H3822_001_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	1	0	1	1	1	H3822_001_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	2	0	1	1	1	H3822_002_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	2	0	1	1	1	H3822_002_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3822	2	0	1	1	1	H3822_002_0	4	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	2	0	1	1	1	H3822_002_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	2	0	1	1	1	H3822_002_0	4	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	2	0	1	1	1	H3822_002_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	7	0	1	2	1	H3822_007_0	5	Preferred Generic	4	11	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	7	0	1	2	1	H3822_007_0	5	Preferred Generic	4	11	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3822	7	0	1	2	1	H3822_007_0	5	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	7	0	1	2	1	H3822_007_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	7	0	1	2	1	H3822_007_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	7	0	1	2	1	H3822_007_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	8	0	1	2	1	H3822_008_0	5	Preferred Generic	4	11	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	8	0	1	2	1	H3822_008_0	5	Preferred Generic	4	11	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3822	8	0	1	2	1	H3822_008_0	5	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	8	0	1	2	1	H3822_008_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	8	0	1	2	1	H3822_008_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3822	8	0	1	2	1	H3822_008_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3832	7	0	1	4	1	H3832_007_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	5	5																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	7	0	1	4	1	H3832_007_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	20	20																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	7	0	1	4	1	H3832_007_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	7	0	1	4	1	H3832_007_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	7	0	1	4	1	H3832_007_0	5	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	8	0	1	4	1	H3832_008_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	4	4																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	8	0	1	4	1	H3832_008_0	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	4	4																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3832	8	0	1	4	1	H3832_008_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	11	22	33																			11	11	11																11				11		0.37			0.37			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	8	0	1	4	1	H3832_008_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	8	0	1	4	1	H3832_008_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	8	0	1	4	1	H3832_008_0	5	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	9	0	1	4	1	H3832_009_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4.5	9	13.5																			4.5	4.5	4.5																4.5				4.5		0.15			0.15			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	9	0	1	4	1	H3832_009_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	12	12																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	9	0	1	4	1	H3832_009_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	9	0	1	4	1	H3832_009_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	9	0	1	4	1	H3832_009_0	5	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	10	0	1	4	1	H3832_010_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	4	4																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	10	0	1	4	1	H3832_010_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	4	4																4				4		0.13			0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3832	10	0	1	4	1	H3832_010_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	11	22	33																			11	11	11																11				11		0.37			0.37			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	10	0	1	4	1	H3832_010_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	10	0	1	4	1	H3832_010_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3832	10	0	1	4	1	H3832_010_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3864	6	0	1	1	1	H3864_006_0	7	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	6	0	1	1	1	H3864_006_0	7	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	6	0	1	1	1	H3864_006_0	7	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	6	0	1	1	1	H3864_006_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											74.72	33	33	33				76.24	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	6	0	1	1	1	H3864_006_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	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	6	0	1	1	1	H3864_006_0	7	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	6	0	1	1	1	H3864_006_0	7	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	14	0	1	2	1	H3864_014_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	14	0	1	2	1	H3864_014_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	14	0	1	2	1	H3864_014_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	14	0	1	2	1	H3864_014_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											77.19	33	33	33				76.05	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	14	0	1	2	1	H3864_014_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	14	0	1	2	1	H3864_014_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	14	0	1	2	1	H3864_014_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	21	0	1	1	1	H3864_021_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	21	0	1	1	1	H3864_021_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	21	0	1	1	1	H3864_021_0	5	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	21	0	1	1	1	H3864_021_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											88.69	33	33	33				85.23	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	21	0	1	1	1	H3864_021_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	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	21	0	1	1	1	H3864_021_0	5	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	21	0	1	1	1	H3864_021_0	5	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	24	0	1	2	1	H3864_024_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	24	0	1	2	1	H3864_024_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	24	0	1	2	1	H3864_024_0	5	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	24	0	1	2	1	H3864_024_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31											90.32	33	33	33				89.08	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	24	0	1	2	1	H3864_024_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	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	24	0	1	2	1	H3864_024_0	5	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	24	0	1	2	1	H3864_024_0	5	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	100	1	2				30	60	100	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	27	0	1	1	1	H3864_027_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	27	0	1	1	1	H3864_027_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	27	0	1	1	1	H3864_027_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	27	0	1	1	1	H3864_027_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											99.32	32	32	32				96.5	31	31	31										32	32	32				31	31	31			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	27	0	1	1	1	H3864_027_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	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	27	0	1	1	1	H3864_027_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	27	0	1	1	1	H3864_027_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	29	0	1	2	1	H3864_029_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	29	0	1	2	1	H3864_029_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	29	0	1	2	1	H3864_029_0	8	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	29	0	1	2	1	H3864_029_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											89.18	33	33	33				82.73	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	29	0	1	2	1	H3864_029_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	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	29	0	1	2	1	H3864_029_0	8	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	29	0	1	2	1	H3864_029_0	8	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	32	0	1	1	1	H3864_032_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	32	0	1	1	1	H3864_032_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	32	0	1	1	1	H3864_032_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	32	0	1	1	1	H3864_032_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31											86.04	33	33	33				83.32	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	32	0	1	1	1	H3864_032_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	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	32	0	1	1	1	H3864_032_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	100	1	2				30	60	100	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	32	0	1	1	1	H3864_032_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	100	1	2				30	60	100	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	33	0	1	1	1	H3864_033_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	33	0	1	1	1	H3864_033_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	33	0	1	1	1	H3864_033_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	33	0	1	1	1	H3864_033_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											91.25	33	33	33				90.03	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	33	0	1	1	1	H3864_033_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	33	0	1	1	1	H3864_033_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	33	0	1	1	1	H3864_033_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	34	0	1	1	1	H3864_034_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	34	0	1	1	1	H3864_034_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	34	0	1	1	1	H3864_034_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	34	0	1	1	1	H3864_034_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											88.32	33	33	33				87.51	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	34	0	1	1	1	H3864_034_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	34	0	1	1	1	H3864_034_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	34	0	1	1	1	H3864_034_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	36	0	1	1	1	H3864_036_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	36	0	1	1	1	H3864_036_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	36	0	1	1	1	H3864_036_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	36	0	1	1	1	H3864_036_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											88.22	33	33	33				86.71	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	36	0	1	1	1	H3864_036_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	36	0	1	1	1	H3864_036_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	36	0	1	1	1	H3864_036_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	37	0	1	1	1	H3864_037_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	37	0	1	1	1	H3864_037_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	37	0	1	1	1	H3864_037_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	37	0	1	1	1	H3864_037_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											85.51	33	33	33				85.57	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	37	0	1	1	1	H3864_037_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	37	0	1	1	1	H3864_037_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	37	0	1	1	1	H3864_037_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	38	0	1	1	1	H3864_038_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				0	0	0				7				7			0.23	0.07		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	38	0	1	1	1	H3864_038_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	38	0	1	1	1	H3864_038_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	38	0	1	1	1	H3864_038_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											75.45	33	33	33				77.96	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	38	0	1	1	1	H3864_038_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	38	0	1	1	1	H3864_038_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	38	0	1	1	1	H3864_038_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	39	0	1	1	1	H3864_039_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				0	0	0				7				7			0.23	0.07		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	39	0	1	1	1	H3864_039_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	39	0	1	1	1	H3864_039_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	39	0	1	1	1	H3864_039_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											73.95	33	33	33				77.69	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	39	0	1	1	1	H3864_039_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	39	0	1	1	1	H3864_039_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	39	0	1	1	1	H3864_039_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	40	0	1	1	1	H3864_040_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	40	0	1	1	1	H3864_040_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	40	0	1	1	1	H3864_040_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	40	0	1	1	1	H3864_040_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											90.13	33	33	33				87.17	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	40	0	1	1	1	H3864_040_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	40	0	1	1	1	H3864_040_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	40	0	1	1	1	H3864_040_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3864	41	0	1	1	1	H3864_041_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	41	0	1	1	1	H3864_041_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	41	0	1	1	1	H3864_041_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	41	0	1	1	1	H3864_041_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											82.49	33	33	33				84.36	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	41	0	1	1	1	H3864_041_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	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	41	0	1	1	1	H3864_041_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H3864	41	0	1	1	1	H3864_041_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H3890	1	0	1	4	1	H3890_001_0	10	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	10.5	14																			7	10.5	14																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	1	0	1	4	1	H3890_001_0	10	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	22.5	30																			15	22.5	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	1	0	1	4	1	H3890_001_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	70.5	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	1	0	1	4	1	H3890_001_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	150	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	1	0	1	4	1	H3890_001_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	2	0	1	4	1	H3890_002_0	10	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	6	8																			4	6	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	2	0	1	4	1	H3890_002_0	10	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	18	24																			12	18	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	2	0	1	4	1	H3890_002_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	70.5	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	2	0	1	4	1	H3890_002_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	150	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	2	0	1	4	1	H3890_002_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	4	0	1	4	1	H3890_004_0	11	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	4.5	6																			3	4.5	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	4	0	1	4	1	H3890_004_0	11	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	15	20																			10	15	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	4	0	1	4	1	H3890_004_0	11	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	60	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	4	0	1	4	1	H3890_004_0	11	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	90	180	270																			90	135	180																90				90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3890	4	0	1	4	1	H3890_004_0	11	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	6	0	1	1	1	H3907_006_0	14	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	6	0	1	1	1	H3907_006_0	14	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	6	0	1	1	1	H3907_006_0	14	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	6	0	1	1	1	H3907_006_0	14	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	6	0	1	1	1	H3907_006_0	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											559.18	33						818.64	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	29	0	1	1	1	H3907_029_0	12	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	29	0	1	1	1	H3907_029_0	12	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	29	0	1	1	1	H3907_029_0	12	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	29	0	1	1	1	H3907_029_0	12	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	29	0	1	1	1	H3907_029_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											611.53	33						842.84	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	37	0	1	1	1	H3907_037_0	12	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	37	0	1	1	1	H3907_037_0	12	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	37	0	1	1	1	H3907_037_0	12	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	37	0	1	1	1	H3907_037_0	12	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	37	0	1	1	1	H3907_037_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											721.65	33						770.97	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	44	0	1	1	1	H3907_044_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	44	0	1	1	1	H3907_044_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	44	0	1	1	1	H3907_044_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	44	0	1	1	1	H3907_044_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	44	0	1	1	1	H3907_044_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											617.71	33						728.43	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	45	0	1	1	1	H3907_045_0	9	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	45	0	1	1	1	H3907_045_0	9	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	45	0	1	1	1	H3907_045_0	9	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	45	0	1	1	1	H3907_045_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	45	0	1	1	1	H3907_045_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											712.97	33						754.9	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	46	0	1	1	1	H3907_046_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	46	0	1	1	1	H3907_046_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	46	0	1	1	1	H3907_046_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	46	0	1	1	1	H3907_046_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	46	0	1	1	1	H3907_046_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											902.85	33						969.05	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	47	0	1	1	1	H3907_047_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	47	0	1	1	1	H3907_047_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	47	0	1	1	1	H3907_047_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	47	0	1	1	1	H3907_047_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	47	0	1	1	1	H3907_047_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											618.57	33						847.67	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	48	0	1	1	1	H3907_048_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	48	0	1	1	1	H3907_048_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	48	0	1	1	1	H3907_048_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	48	0	1	1	1	H3907_048_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	48	0	1	1	1	H3907_048_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											604.48	33						805.71	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	49	0	1	1	1	H3907_049_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	49	0	1	1	1	H3907_049_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	49	0	1	1	1	H3907_049_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	49	0	1	1	1	H3907_049_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	49	0	1	1	1	H3907_049_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											630.42	33						880.03	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	50	0	1	1	1	H3907_050_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	50	0	1	1	1	H3907_050_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	50	0	1	1	1	H3907_050_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	50	0	1	1	1	H3907_050_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	50	0	1	1	1	H3907_050_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											610.82	33						718.62	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	51	0	1	1	1	H3907_051_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	51	0	1	1	1	H3907_051_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	51	0	1	1	1	H3907_051_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	51	0	1	1	1	H3907_051_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	51	0	1	1	1	H3907_051_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											824.57	33						793.61	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	52	0	1	1	1	H3907_052_0	9	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	52	0	1	1	1	H3907_052_0	9	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	52	0	1	1	1	H3907_052_0	9	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	52	0	1	1	1	H3907_052_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3907	52	0	1	1	1	H3907_052_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											746.14	33						769.94	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	1	0	1	4	1	H3909_001_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					1	2	2					1	2	2																9				9			0.3	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	1	0	1	4	1	H3909_001_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					9	18	18					9	18	18																20				20			0.67	0.3	0.3			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	1	0	1	4	1	H3909_001_0	5	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	1	0	1	4	1	H3909_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	1	0	1	4	1	H3909_001_0	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	9	0	1	4	1	H3909_009_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					1	2	2					1	2	2																9				9			0.3	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	9	0	1	4	1	H3909_009_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					9	18	18					9	18	18																20				20			0.67	0.3	0.3			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	9	0	1	4	1	H3909_009_0	5	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	9	0	1	4	1	H3909_009_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	9	0	1	4	1	H3909_009_0	5	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	14	0	1	4	1	H3909_014_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	4					2	4	4																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	14	0	1	4	1	H3909_014_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	20					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	14	0	1	4	1	H3909_014_0	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	14	0	1	4	1	H3909_014_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	14	0	1	4	1	H3909_014_0	8	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	15	0	1	4	1	H3909_015_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	4					2	4	4																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	15	0	1	4	1	H3909_015_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	20					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	15	0	1	4	1	H3909_015_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	15	0	1	4	1	H3909_015_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3909	15	0	1	4	1	H3909_015_0	6	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	1	0	1	4	1	H3916_001_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	1	0	1	4	1	H3916_001_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3916	1	0	1	4	1	H3916_001_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	1	0	1	4	1	H3916_001_0	4	Generic	4	1	1	2	2	3		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3916	1	0	1	4	1	H3916_001_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	1	0	1	4	1	H3916_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	1	0	1	4	1	H3916_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1298.11	33						1298.11	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	2	0	1	4	1	H3916_002_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	2	0	1	4	1	H3916_002_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3916	2	0	1	4	1	H3916_002_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	2	0	1	4	1	H3916_002_0	4	Generic	4	1	1	2	2	3		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3916	2	0	1	4	1	H3916_002_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	2	0	1	4	1	H3916_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	2	0	1	4	1	H3916_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1386.1	33						1386.1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	5	0	1	4	1	H3916_005_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	5	0	1	4	1	H3916_005_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3916	5	0	1	4	1	H3916_005_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	5	0	1	4	1	H3916_005_0	4	Generic	4	1	1	2	2	3		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3916	5	0	1	4	1	H3916_005_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	5	0	1	4	1	H3916_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	5	0	1	4	1	H3916_005_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1362.16	33						1362.16	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	15	0	1	4	1	H3916_015_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	15	0	1	4	1	H3916_015_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	15	0	1	4	1	H3916_015_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	15	0	1	4	1	H3916_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	15	0	1	4	1	H3916_015_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1275.73	33						1275.73	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	18	0	1	4	1	H3916_018_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	18	0	1	4	1	H3916_018_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	18	0	1	4	1	H3916_018_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	18	0	1	4	1	H3916_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	18	0	1	4	1	H3916_018_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1195	33						1195	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	22	0	1	4	1	H3916_022_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	22	0	1	4	1	H3916_022_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	22	0	1	4	1	H3916_022_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	22	0	1	4	1	H3916_022_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	22	0	1	4	1	H3916_022_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1285.54	33						1285.54	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	24	0	1	4	1	H3916_024_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	24	0	1	4	1	H3916_024_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	24	0	1	4	1	H3916_024_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	24	0	1	4	1	H3916_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	24	0	1	4	1	H3916_024_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1461.82	33						1461.82	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	32	0	1	4	1	H3916_032_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	32	0	1	4	1	H3916_032_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	32	0	1	4	1	H3916_032_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	32	0	1	4	1	H3916_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	32	0	1	4	1	H3916_032_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1011.7	33						1011.7	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	33	0	1	4	1	H3916_033_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	33	0	1	4	1	H3916_033_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	33	0	1	4	1	H3916_033_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	33	0	1	4	1	H3916_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	33	0	1	4	1	H3916_033_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1280.28	33						1280.28	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	1	1	4	1	H3916_034_1	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	1	1	4	1	H3916_034_1	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	1	1	4	1	H3916_034_1	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	1	1	4	1	H3916_034_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	1	1	4	1	H3916_034_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.84	33						1094.84	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	3	1	4	1	H3916_034_3	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	3	1	4	1	H3916_034_3	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	3	1	4	1	H3916_034_3	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	3	1	4	1	H3916_034_3	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	3	1	4	1	H3916_034_3	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.84	33						1094.84	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	4	1	4	1	H3916_034_4	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	4	1	4	1	H3916_034_4	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	4	1	4	1	H3916_034_4	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	4	1	4	1	H3916_034_4	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	4	1	4	1	H3916_034_4	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.84	33						1094.84	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	5	1	4	1	H3916_034_5	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	5	1	4	1	H3916_034_5	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	5	1	4	1	H3916_034_5	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	5	1	4	1	H3916_034_5	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	34	5	1	4	1	H3916_034_5	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.84	33						1094.84	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	1	1	4	1	H3916_035_1	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	1	1	4	1	H3916_035_1	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								20		60					9		27													60						27				20				20			0.65	0.29				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	1	1	4	1	H3916_035_1	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	1	1	4	1	H3916_035_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						280				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	1	1	4	1	H3916_035_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1144.38	33						1144.38	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	2	1	4	1	H3916_035_2	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	2	1	4	1	H3916_035_2	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								20		60					9		27													60						27				20				20			0.65	0.29				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	2	1	4	1	H3916_035_2	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	2	1	4	1	H3916_035_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						280				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	2	1	4	1	H3916_035_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1144.38	33						1144.38	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	3	1	4	1	H3916_035_3	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	3	1	4	1	H3916_035_3	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								20		60					9		27													60						27				20				20			0.65	0.29				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	3	1	4	1	H3916_035_3	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	3	1	4	1	H3916_035_3	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						280				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	35	3	1	4	1	H3916_035_3	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1144.38	33						1144.38	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	36	0	1	4	1	H3916_036_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	36	0	1	4	1	H3916_036_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	36	0	1	4	1	H3916_036_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	36	0	1	4	1	H3916_036_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	36	0	1	4	1	H3916_036_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											764.56	33						764.56	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	1	1	4	1	H3916_037_1	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	1	1	4	1	H3916_037_1	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	1	1	4	1	H3916_037_1	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	1	1	4	1	H3916_037_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	1	1	4	1	H3916_037_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1213.3	33						1213.3	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	2	1	4	1	H3916_037_2	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	2	1	4	1	H3916_037_2	6	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	2	1	4	1	H3916_037_2	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	2	1	4	1	H3916_037_2	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	2	1	4	1	H3916_037_2	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1213.3	33						1213.3	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	3	1	4	1	H3916_037_3	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	3	1	4	1	H3916_037_3	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	3	1	4	1	H3916_037_3	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	3	1	4	1	H3916_037_3	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	3	1	4	1	H3916_037_3	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1213.3	33						1213.3	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	4	1	4	1	H3916_037_4	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	4	1	4	1	H3916_037_4	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	4	1	4	1	H3916_037_4	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	4	1	4	1	H3916_037_4	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	37	4	1	4	1	H3916_037_4	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1213.3	33						1213.3	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	38	0	1	4	1	H3916_038_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	38	0	1	4	1	H3916_038_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	38	0	1	4	1	H3916_038_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	38	0	1	4	1	H3916_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	38	0	1	4	1	H3916_038_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1017.62	33						1017.62	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	39	0	1	4	1	H3916_039_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	39	0	1	4	1	H3916_039_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	39	0	1	4	1	H3916_039_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	39	0	1	4	1	H3916_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3916	39	0	1	4	1	H3916_039_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											782.27	33						782.27	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3923	13	0	1	4	1	H3923_013_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					0	0	0											10	20	30				0	0	0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	13	0	1	4	1	H3923_013_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	13	0	1	4	1	H3923_013_0	3	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	13	0	1	4	1	H3923_013_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	13	0	1	4	1	H3923_013_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1038.29	33						1038.29	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	13	0	1	4	1	H3923_013_0	3	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	17	0	1	4	1	H3923_017_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8	16	24					0	0	0											8	16	24				0	0	0					8			8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	17	0	1	4	1	H3923_017_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	17	0	1	4	1	H3923_017_0	3	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	17	0	1	4	1	H3923_017_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	17	0	1	4	1	H3923_017_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1220.37	33						1220.37	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3923	17	0	1	4	1	H3923_017_0	3	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3924	59	13	1	4	1	H3924_059_13	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	13	1	4	1	H3924_059_13	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	13	1	4	1	H3924_059_13	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	13	1	4	1	H3924_059_13	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	13	1	4	1	H3924_059_13	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	13	1	4	1	H3924_059_13	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	13	1	4	1	H3924_059_13	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	13	1	4	1	H3924_059_13	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	14	1	4	1	H3924_059_14	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	14	1	4	1	H3924_059_14	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	14	1	4	1	H3924_059_14	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	14	1	4	1	H3924_059_14	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	14	1	4	1	H3924_059_14	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	14	1	4	1	H3924_059_14	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	14	1	4	1	H3924_059_14	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	14	1	4	1	H3924_059_14	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	15	1	4	1	H3924_059_15	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	15	1	4	1	H3924_059_15	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	15	1	4	1	H3924_059_15	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	15	1	4	1	H3924_059_15	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	15	1	4	1	H3924_059_15	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	15	1	4	1	H3924_059_15	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	15	1	4	1	H3924_059_15	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	15	1	4	1	H3924_059_15	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	16	1	4	1	H3924_059_16	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	16	1	4	1	H3924_059_16	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	16	1	4	1	H3924_059_16	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	16	1	4	1	H3924_059_16	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	16	1	4	1	H3924_059_16	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	16	1	4	1	H3924_059_16	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	16	1	4	1	H3924_059_16	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	16	1	4	1	H3924_059_16	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	17	1	4	1	H3924_059_17	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	17	1	4	1	H3924_059_17	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	17	1	4	1	H3924_059_17	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	17	1	4	1	H3924_059_17	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	17	1	4	1	H3924_059_17	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	17	1	4	1	H3924_059_17	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	17	1	4	1	H3924_059_17	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	17	1	4	1	H3924_059_17	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	18	1	4	1	H3924_059_18	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	18	1	4	1	H3924_059_18	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	59	18	1	4	1	H3924_059_18	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	18	1	4	1	H3924_059_18	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	18	1	4	1	H3924_059_18	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	18	1	4	1	H3924_059_18	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	18	1	4	1	H3924_059_18	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	59	18	1	4	1	H3924_059_18	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	13	1	4	1	H3924_060_13	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	13	1	4	1	H3924_060_13	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	13	1	4	1	H3924_060_13	7	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	13	1	4	1	H3924_060_13	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	13	1	4	1	H3924_060_13	7	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	13	1	4	1	H3924_060_13	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	13	1	4	1	H3924_060_13	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	13	1	4	1	H3924_060_13	7	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	14	1	4	1	H3924_060_14	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	14	1	4	1	H3924_060_14	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	14	1	4	1	H3924_060_14	7	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	14	1	4	1	H3924_060_14	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	14	1	4	1	H3924_060_14	7	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	14	1	4	1	H3924_060_14	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	14	1	4	1	H3924_060_14	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	14	1	4	1	H3924_060_14	7	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	15	1	4	1	H3924_060_15	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	15	1	4	1	H3924_060_15	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	15	1	4	1	H3924_060_15	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	15	1	4	1	H3924_060_15	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	15	1	4	1	H3924_060_15	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	15	1	4	1	H3924_060_15	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	15	1	4	1	H3924_060_15	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	15	1	4	1	H3924_060_15	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	16	1	4	1	H3924_060_16	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	16	1	4	1	H3924_060_16	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	16	1	4	1	H3924_060_16	7	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	16	1	4	1	H3924_060_16	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	16	1	4	1	H3924_060_16	7	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	16	1	4	1	H3924_060_16	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	16	1	4	1	H3924_060_16	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	16	1	4	1	H3924_060_16	7	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	17	1	4	1	H3924_060_17	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	17	1	4	1	H3924_060_17	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	17	1	4	1	H3924_060_17	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	17	1	4	1	H3924_060_17	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	17	1	4	1	H3924_060_17	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	17	1	4	1	H3924_060_17	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	17	1	4	1	H3924_060_17	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	17	1	4	1	H3924_060_17	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	18	1	4	1	H3924_060_18	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	18	1	4	1	H3924_060_18	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	60	18	1	4	1	H3924_060_18	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	18	1	4	1	H3924_060_18	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	18	1	4	1	H3924_060_18	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	18	1	4	1	H3924_060_18	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	18	1	4	1	H3924_060_18	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	60	18	1	4	1	H3924_060_18	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	13	1	4	1	H3924_062_13	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	13	1	4	1	H3924_062_13	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	13	1	4	1	H3924_062_13	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	13	1	4	1	H3924_062_13	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	13	1	4	1	H3924_062_13	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	13	1	4	1	H3924_062_13	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	13	1	4	1	H3924_062_13	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	13	1	4	1	H3924_062_13	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	14	1	4	1	H3924_062_14	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	14	1	4	1	H3924_062_14	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	14	1	4	1	H3924_062_14	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	14	1	4	1	H3924_062_14	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	14	1	4	1	H3924_062_14	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	14	1	4	1	H3924_062_14	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	14	1	4	1	H3924_062_14	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	14	1	4	1	H3924_062_14	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	15	1	4	1	H3924_062_15	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	15	1	4	1	H3924_062_15	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	15	1	4	1	H3924_062_15	4	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	15	1	4	1	H3924_062_15	4	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	15	1	4	1	H3924_062_15	4	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	15	1	4	1	H3924_062_15	4	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	15	1	4	1	H3924_062_15	4	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	15	1	4	1	H3924_062_15	4	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	16	1	4	1	H3924_062_16	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	16	1	4	1	H3924_062_16	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	16	1	4	1	H3924_062_16	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	16	1	4	1	H3924_062_16	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	16	1	4	1	H3924_062_16	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	16	1	4	1	H3924_062_16	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	16	1	4	1	H3924_062_16	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	16	1	4	1	H3924_062_16	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	17	1	4	1	H3924_062_17	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	17	1	4	1	H3924_062_17	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	17	1	4	1	H3924_062_17	4	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	17	1	4	1	H3924_062_17	4	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	17	1	4	1	H3924_062_17	4	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	17	1	4	1	H3924_062_17	4	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	17	1	4	1	H3924_062_17	4	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	17	1	4	1	H3924_062_17	4	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	18	1	4	1	H3924_062_18	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	18	1	4	1	H3924_062_18	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3924	62	18	1	4	1	H3924_062_18	4	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	18	1	4	1	H3924_062_18	4	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	18	1	4	1	H3924_062_18	4	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	18	1	4	1	H3924_062_18	4	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	18	1	4	1	H3924_062_18	4	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3924	62	18	1	4	1	H3924_062_18	4	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3928	1	0	1	1	1	H3928_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	1	0	1	1	1	H3928_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3928	1	0	1	1	1	H3928_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	1	0	1	1	1	H3928_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3928	1	0	1	1	1	H3928_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	1	0	1	1	1	H3928_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	1	0	1	1	1	H3928_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											706.9	30						669.42	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	2	0	1	1	1	H3928_002_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	2	0	1	1	1	H3928_002_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3928	2	0	1	1	1	H3928_002_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	2	0	1	1	1	H3928_002_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3928	2	0	1	1	1	H3928_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	2	0	1	1	1	H3928_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3928	2	0	1	1	1	H3928_002_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											651.33	30						613.23	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3930	1	0	1	1	1	H3930_001_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	1	0	1	1	1	H3930_001_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	1	0	1	1	1	H3930_001_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	1	0	1	1	1	H3930_001_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	1	0	1	1	1	H3930_001_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	2	0	1	1	1	H3930_002_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	2	0	1	1	1	H3930_002_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	2	0	1	1	1	H3930_002_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	2	0	1	1	1	H3930_002_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	2	0	1	1	1	H3930_002_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	3	0	1	1	1	H3930_003_0	9	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	3	0	1	1	1	H3930_003_0	9	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	3	0	1	1	1	H3930_003_0	9	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	3	0	1	1	1	H3930_003_0	9	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3930	3	0	1	1	1	H3930_003_0	9	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3931	4	0	1	1	1	H3931_004_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	4	0	1	1	1	H3931_004_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	4	0	1	1	1	H3931_004_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	4	0	1	1	1	H3931_004_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	4	0	1	1	1	H3931_004_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	4	0	1	1	1	H3931_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	4	0	1	1	1	H3931_004_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											925.59	33						950.13	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	64	0	1	1	1	H3931_064_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	64	0	1	1	1	H3931_064_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	64	0	1	1	1	H3931_064_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	64	0	1	1	1	H3931_064_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	64	0	1	1	1	H3931_064_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	64	0	1	1	1	H3931_064_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	64	0	1	1	1	H3931_064_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											977.19	33						1008.3	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	70	0	1	1	1	H3931_070_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	70	0	1	1	1	H3931_070_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	70	0	1	1	1	H3931_070_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	70	0	1	1	1	H3931_070_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	70	0	1	1	1	H3931_070_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	70	0	1	1	1	H3931_070_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	70	0	1	1	1	H3931_070_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											933.1	33						906.86	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	81	0	1	1	1	H3931_081_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	81	0	1	1	1	H3931_081_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	81	0	1	1	1	H3931_081_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	81	0	1	1	1	H3931_081_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	81	0	1	1	1	H3931_081_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	81	0	1	1	1	H3931_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	81	0	1	1	1	H3931_081_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											617.52	30						595.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	91	0	1	1	1	H3931_091_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	91	0	1	1	1	H3931_091_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	91	0	1	1	1	H3931_091_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	91	0	1	1	1	H3931_091_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	91	0	1	1	1	H3931_091_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	91	0	1	1	1	H3931_091_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	91	0	1	1	1	H3931_091_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											583.77	33						532	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	92	0	1	1	1	H3931_092_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	92	0	1	1	1	H3931_092_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	92	0	1	1	1	H3931_092_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	92	0	1	1	1	H3931_092_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	92	0	1	1	1	H3931_092_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	92	0	1	1	1	H3931_092_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	92	0	1	1	1	H3931_092_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											683.62	33						655.71	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	93	0	1	1	1	H3931_093_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	93	0	1	1	1	H3931_093_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	93	0	1	1	1	H3931_093_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	93	0	1	1	1	H3931_093_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	93	0	1	1	1	H3931_093_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	93	0	1	1	1	H3931_093_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	93	0	1	1	1	H3931_093_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											626.74	33						593.27	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	94	0	1	1	1	H3931_094_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	94	0	1	1	1	H3931_094_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	94	0	1	1	1	H3931_094_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	94	0	1	1	1	H3931_094_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	94	0	1	1	1	H3931_094_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	94	0	1	1	1	H3931_094_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	94	0	1	1	1	H3931_094_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											735.6	33						689.58	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	95	0	1	1	1	H3931_095_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	95	0	1	1	1	H3931_095_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	95	0	1	1	1	H3931_095_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	95	0	1	1	1	H3931_095_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	95	0	1	1	1	H3931_095_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	95	0	1	1	1	H3931_095_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	95	0	1	1	1	H3931_095_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											737.7	33						679.71	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	96	0	1	1	1	H3931_096_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	96	0	1	1	1	H3931_096_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	96	0	1	1	1	H3931_096_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	96	0	1	1	1	H3931_096_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	96	0	1	1	1	H3931_096_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	96	0	1	1	1	H3931_096_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	96	0	1	1	1	H3931_096_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											680.78	30						626.86	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	97	0	1	1	1	H3931_097_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	97	0	1	1	1	H3931_097_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	97	0	1	1	1	H3931_097_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	97	0	1	1	1	H3931_097_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	97	0	1	1	1	H3931_097_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	97	0	1	1	1	H3931_097_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	97	0	1	1	1	H3931_097_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											703.24	33						652.38	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	98	0	1	1	1	H3931_098_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	98	0	1	1	1	H3931_098_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	98	0	1	1	1	H3931_098_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	98	0	1	1	1	H3931_098_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	98	0	1	1	1	H3931_098_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	98	0	1	1	1	H3931_098_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	98	0	1	1	1	H3931_098_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											693.3	33						658.27	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	99	0	1	1	1	H3931_099_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	99	0	1	1	1	H3931_099_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	99	0	1	1	1	H3931_099_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	99	0	1	1	1	H3931_099_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	99	0	1	1	1	H3931_099_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	99	0	1	1	1	H3931_099_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	99	0	1	1	1	H3931_099_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											934.79	33						881.24	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	100	0	1	1	1	H3931_100_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	100	0	1	1	1	H3931_100_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	100	0	1	1	1	H3931_100_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	100	0	1	1	1	H3931_100_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	100	0	1	1	1	H3931_100_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	100	0	1	1	1	H3931_100_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	100	0	1	1	1	H3931_100_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											769.33	33						723.49	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	101	0	1	1	1	H3931_101_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	101	0	1	1	1	H3931_101_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	101	0	1	1	1	H3931_101_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	101	0	1	1	1	H3931_101_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	101	0	1	1	1	H3931_101_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	101	0	1	1	1	H3931_101_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	101	0	1	1	1	H3931_101_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											835.5	33						806.11	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	102	0	1	1	1	H3931_102_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	102	0	1	1	1	H3931_102_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	102	0	1	1	1	H3931_102_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	102	0	1	1	1	H3931_102_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	102	0	1	1	1	H3931_102_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	102	0	1	1	1	H3931_102_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	102	0	1	1	1	H3931_102_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											967.02	33						968.08	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	104	0	1	1	1	H3931_104_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	104	0	1	1	1	H3931_104_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	104	0	1	1	1	H3931_104_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_104_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_104_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	104	0	1	1	1	H3931_104_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	104	0	1	1	1	H3931_104_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											773.91	33						710	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	105	0	1	1	1	H3931_105_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	105	0	1	1	1	H3931_105_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	105	0	1	1	1	H3931_105_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_105_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_105_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	105	0	1	1	1	H3931_105_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	105	0	1	1	1	H3931_105_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											621.77	27						601.12	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	106	0	1	1	1	H3931_106_0	8	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					5	10	15											15	30	45				5	10	15					15			15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	106	0	1	1	1	H3931_106_0	8	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					5	10	15											15	30	45				5	10	15					15			15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	106	0	1	1	1	H3931_106_0	8	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	21											20	40	60				7	14	21					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	106	0	1	1	1	H3931_106_0	8	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	21											20	40	60				7	14	21					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	106	0	1	1	1	H3931_106_0	8	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	106	0	1	1	1	H3931_106_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	106	0	1	1	1	H3931_106_0	8	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											633.21	30						589.62	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	107	0	1	1	1	H3931_107_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	107	0	1	1	1	H3931_107_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	107	0	1	1	1	H3931_107_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_107_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_107_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	107	0	1	1	1	H3931_107_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	107	0	1	1	1	H3931_107_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											714.15	30						660.85	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	108	0	1	1	1	H3931_108_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	108	0	1	1	1	H3931_108_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	108	0	1	1	1	H3931_108_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_108_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_108_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	108	0	1	1	1	H3931_108_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	108	0	1	1	1	H3931_108_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.92	30						628.59	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	109	0	1	1	1	H3931_109_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	109	0	1	1	1	H3931_109_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	109	0	1	1	1	H3931_109_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_109_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_109_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	109	0	1	1	1	H3931_109_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	109	0	1	1	1	H3931_109_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											690.46	30						661.22	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	110	0	1	1	1	H3931_110_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	110	0	1	1	1	H3931_110_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	110	0	1	1	1	H3931_110_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_110_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_110_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	110	0	1	1	1	H3931_110_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	110	0	1	1	1	H3931_110_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											616.68	30						581.19	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	112	0	1	1	1	H3931_112_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	112	0	1	1	1	H3931_112_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	112	0	1	1	1	H3931_112_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_112_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_112_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	112	0	1	1	1	H3931_112_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	112	0	1	1	1	H3931_112_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											851.28	30						786.14	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	115	0	1	1	1	H3931_115_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	115	0	1	1	1	H3931_115_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	115	0	1	1	1	H3931_115_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_115_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	1	1	H3931_115_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	115	0	1	1	1	H3931_115_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	115	0	1	1	1	H3931_115_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											852.84	33						808.08	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	118	0	1	1	1	H3931_118_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	118	0	1	1	1	H3931_118_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	118	0	1	1	1	H3931_118_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	118	0	1	1	1	H3931_118_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	118	0	1	1	1	H3931_118_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	118	0	1	1	1	H3931_118_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	118	0	1	1	1	H3931_118_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											665.8	30						631.32	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	122	0	1	1	1	H3931_122_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	122	0	1	1	1	H3931_122_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	122	0	1	1	1	H3931_122_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	122	0	1	1	1	H3931_122_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	122	0	1	1	1	H3931_122_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	122	0	1	1	1	H3931_122_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	122	0	1	1	1	H3931_122_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											619.99	28						590.41	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	124	0	1	1	1	H3931_124_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	124	0	1	1	1	H3931_124_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	124	0	1	1	1	H3931_124_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	124	0	1	1	1	H3931_124_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	124	0	1	1	1	H3931_124_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	124	0	1	1	1	H3931_124_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	124	0	1	1	1	H3931_124_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											824.02	33						779.65	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	126	0	1	1	1	H3931_126_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	126	0	1	1	1	H3931_126_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	126	0	1	1	1	H3931_126_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	126	0	1	1	1	H3931_126_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	126	0	1	1	1	H3931_126_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	126	0	1	1	1	H3931_126_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	126	0	1	1	1	H3931_126_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1012.58	33						1059.79	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	127	0	1	1	1	H3931_127_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	127	0	1	1	1	H3931_127_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	127	0	1	1	1	H3931_127_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	127	0	1	1	1	H3931_127_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	127	0	1	1	1	H3931_127_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	127	0	1	1	1	H3931_127_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	127	0	1	1	1	H3931_127_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											673.65	33						634.24	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	129	0	1	1	1	H3931_129_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	129	0	1	1	1	H3931_129_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	129	0	1	1	1	H3931_129_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	129	0	1	1	1	H3931_129_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	129	0	1	1	1	H3931_129_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	129	0	1	1	1	H3931_129_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	129	0	1	1	1	H3931_129_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											666.45	33						621.97	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	130	0	1	1	1	H3931_130_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	130	0	1	1	1	H3931_130_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	130	0	1	1	1	H3931_130_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	130	0	1	1	1	H3931_130_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	130	0	1	1	1	H3931_130_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	130	0	1	1	1	H3931_130_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	130	0	1	1	1	H3931_130_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.68	33						698.54	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	131	0	1	1	1	H3931_131_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	131	0	1	1	1	H3931_131_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	131	0	1	1	1	H3931_131_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	131	0	1	1	1	H3931_131_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	131	0	1	1	1	H3931_131_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	131	0	1	1	1	H3931_131_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	131	0	1	1	1	H3931_131_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											638.9	27						599.28	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	132	0	1	1	1	H3931_132_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	132	0	1	1	1	H3931_132_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	132	0	1	1	1	H3931_132_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	132	0	1	1	1	H3931_132_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	132	0	1	1	1	H3931_132_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	132	0	1	1	1	H3931_132_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	132	0	1	1	1	H3931_132_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											692.8	30						654.76	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	133	0	1	1	1	H3931_133_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	133	0	1	1	1	H3931_133_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	133	0	1	1	1	H3931_133_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	133	0	1	1	1	H3931_133_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	133	0	1	1	1	H3931_133_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	133	0	1	1	1	H3931_133_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	133	0	1	1	1	H3931_133_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.84	30						626	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	134	0	1	1	1	H3931_134_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	134	0	1	1	1	H3931_134_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	134	0	1	1	1	H3931_134_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	134	0	1	1	1	H3931_134_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	134	0	1	1	1	H3931_134_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	134	0	1	1	1	H3931_134_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	134	0	1	1	1	H3931_134_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.84	30						626	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	140	0	1	1	1	H3931_140_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	140	0	1	1	1	H3931_140_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	140	0	1	1	1	H3931_140_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	140	0	1	1	1	H3931_140_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	140	0	1	1	1	H3931_140_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	140	0	1	1	1	H3931_140_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	140	0	1	1	1	H3931_140_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.81	30						625.98	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	141	0	1	1	1	H3931_141_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	141	0	1	1	1	H3931_141_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	141	0	1	1	1	H3931_141_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	141	0	1	1	1	H3931_141_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	141	0	1	1	1	H3931_141_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	141	0	1	1	1	H3931_141_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	141	0	1	1	1	H3931_141_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.86	30						626.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	142	0	1	1	1	H3931_142_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	142	0	1	1	1	H3931_142_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	142	0	1	1	1	H3931_142_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	142	0	1	1	1	H3931_142_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3931	142	0	1	1	1	H3931_142_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	142	0	1	1	1	H3931_142_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3931	142	0	1	1	1	H3931_142_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											662.05	30						626.11	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3949	13	0	1	1	1	H3949_013_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					1	2	2											6	12	12				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	13	0	1	1	1	H3949_013_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	14					2	4	4											7	14	14				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	13	0	1	1	1	H3949_013_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	13	0	1	1	1	H3949_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	13	0	1	1	1	H3949_013_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											994.28	33						855.36	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	24	0	1	1	1	H3949_024_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					1	2	2											6	12	12				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H3949	24	0	1	1	1	H3949_024_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	20					5	10	10											10	20	20				5	10	0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H3949	24	0	1	1	1	H3949_024_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H3949	24	0	1	1	1	H3949_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H3949	24	0	1	1	1	H3949_024_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											923.66	33						798.9	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H3949	24	0	1	1	1	H3949_024_0	4	Select Diabetic Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	10					5	10	10											5	10	10				5	10	10				5				5			0.17	0.17		0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H3949	30	0	1	1	1	H3949_030_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								6	12	12					1	2	2											6	12	12				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	30	0	1	1	1	H3949_030_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	30					10	20	20											15	30	30				10	20	0				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	30	0	1	1	1	H3949_030_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	30	0	1	1	1	H3949_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	30	0	1	1	1	H3949_030_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											995.4	33						817.82	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	31	0	1	1	1	H3949_031_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					1	2	2											6	12	12				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	31	0	1	1	1	H3949_031_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	30					10	20	20											15	30	30				10	20	0				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	31	0	1	1	1	H3949_031_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	31	0	1	1	1	H3949_031_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	31	0	1	1	1	H3949_031_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											970.94	33						800.88	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	32	0	1	1	1	H3949_032_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					1	2	2											6	12	12				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	32	0	1	1	1	H3949_032_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	14					2	4	4											7	14	14				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	32	0	1	1	1	H3949_032_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	32	0	1	1	1	H3949_032_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	32	0	1	1	1	H3949_032_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											970.94	33						800.88	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	33	0	1	1	1	H3949_033_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					1	2	2											6	12	12				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	33	0	1	1	1	H3949_033_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	14					2	4	4											7	14	14				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	33	0	1	1	1	H3949_033_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	33	0	1	1	1	H3949_033_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3949	33	0	1	1	1	H3949_033_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											970.94	33						800.88	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	20	0	1	1	1	H3952_020_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					1	2	2					1	2	2																9				9			0.3	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	20	0	1	1	1	H3952_020_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					9	18	18					9	18	18																20				20			0.67	0.3	0.3			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	20	0	1	1	1	H3952_020_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	20	0	1	1	1	H3952_020_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	20	0	1	1	1	H3952_020_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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	45	0	1	1	1	H3952_045_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					1	2	2					1	2	2																9				9			0.3	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	45	0	1	1	1	H3952_045_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					9	18	18					9	18	18																20				20			0.67	0.3	0.3			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	45	0	1	1	1	H3952_045_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	45	0	1	1	1	H3952_045_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	45	0	1	1	1	H3952_045_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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	49	0	1	1	1	H3952_049_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					1	2	2					1	2	2																9				9			0.3	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	49	0	1	1	1	H3952_049_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					9	18	18					9	18	18																20				20			0.67	0.3	0.3			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	49	0	1	1	1	H3952_049_0	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	49	0	1	1	1	H3952_049_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	49	0	1	1	1	H3952_049_0	8	Specialty Tier	4	11	1	1	5	1		111	1	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	51	0	1	1	1	H3952_051_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					1	2	2					1	2	2																9				9			0.3	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	51	0	1	1	1	H3952_051_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					9	18	18					9	18	18																20				20			0.67	0.3	0.3			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	51	0	1	1	1	H3952_051_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	51	0	1	1	1	H3952_051_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	51	0	1	1	1	H3952_051_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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	53	0	1	2	1	H3952_053_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	4					2	4	4																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	53	0	1	2	1	H3952_053_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	20					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	53	0	1	2	1	H3952_053_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	53	0	1	2	1	H3952_053_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	53	0	1	2	1	H3952_053_0	6	Specialty Tier	4	11	1	1	5	1		111	1	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	54	0	1	2	1	H3952_054_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	4					2	4	4																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	54	0	1	2	1	H3952_054_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	20					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	54	0	1	2	1	H3952_054_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	54	0	1	2	1	H3952_054_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	54	0	1	2	1	H3952_054_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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	55	0	1	1	1	H3952_055_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	4					2	4	4																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	55	0	1	1	1	H3952_055_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	20					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	55	0	1	1	1	H3952_055_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	55	0	1	1	1	H3952_055_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	55	0	1	1	1	H3952_055_0	7	Specialty Tier	4	11	1	1	5	1		111	1	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	56	0	1	1	1	H3952_056_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	4					2	4	4																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	56	0	1	1	1	H3952_056_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	20					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	56	0	1	1	1	H3952_056_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	56	0	1	1	1	H3952_056_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3952	56	0	1	1	1	H3952_056_0	7	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3954	157	13	1	1	1	H3954_157_13	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	13	1	1	1	H3954_157_13	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	13	1	1	1	H3954_157_13	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	13	1	1	1	H3954_157_13	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	13	1	1	1	H3954_157_13	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	13	1	1	1	H3954_157_13	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	13	1	1	1	H3954_157_13	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	13	1	1	1	H3954_157_13	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	14	1	1	1	H3954_157_14	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	14	1	1	1	H3954_157_14	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	14	1	1	1	H3954_157_14	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	14	1	1	1	H3954_157_14	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	14	1	1	1	H3954_157_14	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	14	1	1	1	H3954_157_14	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	14	1	1	1	H3954_157_14	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	14	1	1	1	H3954_157_14	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	15	1	1	1	H3954_157_15	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	15	1	1	1	H3954_157_15	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	15	1	1	1	H3954_157_15	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	15	1	1	1	H3954_157_15	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	15	1	1	1	H3954_157_15	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	15	1	1	1	H3954_157_15	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	15	1	1	1	H3954_157_15	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	15	1	1	1	H3954_157_15	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	16	1	1	1	H3954_157_16	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	16	1	1	1	H3954_157_16	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	16	1	1	1	H3954_157_16	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	16	1	1	1	H3954_157_16	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	16	1	1	1	H3954_157_16	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	16	1	1	1	H3954_157_16	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	16	1	1	1	H3954_157_16	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	16	1	1	1	H3954_157_16	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	17	1	1	1	H3954_157_17	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	17	1	1	1	H3954_157_17	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	17	1	1	1	H3954_157_17	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	17	1	1	1	H3954_157_17	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	17	1	1	1	H3954_157_17	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	17	1	1	1	H3954_157_17	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	17	1	1	1	H3954_157_17	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	17	1	1	1	H3954_157_17	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	18	1	1	1	H3954_157_18	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	18	1	1	1	H3954_157_18	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	157	18	1	1	1	H3954_157_18	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	18	1	1	1	H3954_157_18	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	18	1	1	1	H3954_157_18	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	18	1	1	1	H3954_157_18	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	18	1	1	1	H3954_157_18	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	157	18	1	1	1	H3954_157_18	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	13	1	1	1	H3954_158_13	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	13	1	1	1	H3954_158_13	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	13	1	1	1	H3954_158_13	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	13	1	1	1	H3954_158_13	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	13	1	1	1	H3954_158_13	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	13	1	1	1	H3954_158_13	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	13	1	1	1	H3954_158_13	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	13	1	1	1	H3954_158_13	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	14	1	1	1	H3954_158_14	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	14	1	1	1	H3954_158_14	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	14	1	1	1	H3954_158_14	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	14	1	1	1	H3954_158_14	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	14	1	1	1	H3954_158_14	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	14	1	1	1	H3954_158_14	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	14	1	1	1	H3954_158_14	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	14	1	1	1	H3954_158_14	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	15	1	1	1	H3954_158_15	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	15	1	1	1	H3954_158_15	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	15	1	1	1	H3954_158_15	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	15	1	1	1	H3954_158_15	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	15	1	1	1	H3954_158_15	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	15	1	1	1	H3954_158_15	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	15	1	1	1	H3954_158_15	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	15	1	1	1	H3954_158_15	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	16	1	1	1	H3954_158_16	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	16	1	1	1	H3954_158_16	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	16	1	1	1	H3954_158_16	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	16	1	1	1	H3954_158_16	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	16	1	1	1	H3954_158_16	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	16	1	1	1	H3954_158_16	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	16	1	1	1	H3954_158_16	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	16	1	1	1	H3954_158_16	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	17	1	1	1	H3954_158_17	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	17	1	1	1	H3954_158_17	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	17	1	1	1	H3954_158_17	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	17	1	1	1	H3954_158_17	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	17	1	1	1	H3954_158_17	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	17	1	1	1	H3954_158_17	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	17	1	1	1	H3954_158_17	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	17	1	1	1	H3954_158_17	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	18	1	1	1	H3954_158_18	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	18	1	1	1	H3954_158_18	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	158	18	1	1	1	H3954_158_18	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	18	1	1	1	H3954_158_18	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	18	1	1	1	H3954_158_18	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	18	1	1	1	H3954_158_18	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	18	1	1	1	H3954_158_18	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	158	18	1	1	1	H3954_158_18	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	13	1	1	1	H3954_159_13	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	13	1	1	1	H3954_159_13	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	13	1	1	1	H3954_159_13	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	13	1	1	1	H3954_159_13	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	13	1	1	1	H3954_159_13	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	13	1	1	1	H3954_159_13	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	13	1	1	1	H3954_159_13	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	13	1	1	1	H3954_159_13	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	14	1	1	1	H3954_159_14	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	14	1	1	1	H3954_159_14	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	14	1	1	1	H3954_159_14	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	14	1	1	1	H3954_159_14	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	14	1	1	1	H3954_159_14	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	14	1	1	1	H3954_159_14	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	14	1	1	1	H3954_159_14	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	14	1	1	1	H3954_159_14	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	15	1	1	1	H3954_159_15	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	15	1	1	1	H3954_159_15	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	15	1	1	1	H3954_159_15	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	15	1	1	1	H3954_159_15	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	15	1	1	1	H3954_159_15	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	15	1	1	1	H3954_159_15	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	15	1	1	1	H3954_159_15	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	15	1	1	1	H3954_159_15	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	16	1	1	1	H3954_159_16	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	16	1	1	1	H3954_159_16	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	16	1	1	1	H3954_159_16	7	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	16	1	1	1	H3954_159_16	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	16	1	1	1	H3954_159_16	7	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	16	1	1	1	H3954_159_16	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	16	1	1	1	H3954_159_16	7	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	16	1	1	1	H3954_159_16	7	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	17	1	1	1	H3954_159_17	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	17	1	1	1	H3954_159_17	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	17	1	1	1	H3954_159_17	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	17	1	1	1	H3954_159_17	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	17	1	1	1	H3954_159_17	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	17	1	1	1	H3954_159_17	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	17	1	1	1	H3954_159_17	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	17	1	1	1	H3954_159_17	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	18	1	1	1	H3954_159_18	6	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	18	1	1	1	H3954_159_18	6	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					4.5																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	159	18	1	1	1	H3954_159_18	6	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					30																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	18	1	1	1	H3954_159_18	6	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	18	1	1	1	H3954_159_18	6	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	18	1	1	1	H3954_159_18	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	18	1	1	1	H3954_159_18	6	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	159	18	1	1	1	H3954_159_18	6	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	160	0	1	1	1	H3954_160_0	5	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	160	0	1	1	1	H3954_160_0	5	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				1	2			100				30		31	3		7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3954	160	0	1	1	1	H3954_160_0	5	Generic	4	1	1	2	2	1	110		1	100		1	30		100				2	2			100				30		31	20		50																					0																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	160	0	1	1	1	H3954_160_0	5	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		100				2	2			100				30		31	47		117.5																					70.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	160	0	1	1	1	H3954_160_0	5	Non-Preferred Brand	4	11	1	2	4	1	110		1	100		1	30		100				2	2			100				30		31	100		250																					150																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	160	0	1	1	1	H3954_160_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	160	0	1	1	1	H3954_160_0	5	Vaccines	4	11	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H3954	160	0	1	1	1	H3954_160_0	5	Vaccines	4	11	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H3957	31	0	1	2	1	H3957_031_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	31	0	1	2	1	H3957_031_0	5	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	31	0	1	2	1	H3957_031_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	31	0	1	2	1	H3957_031_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	31	0	1	2	1	H3957_031_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1067.47	33						1067.47	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	39	0	1	1	1	H3957_039_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	39	0	1	1	1	H3957_039_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	39	0	1	1	1	H3957_039_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	39	0	1	1	1	H3957_039_0	4	Generic	4	1	1	2	2	3		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	39	0	1	1	1	H3957_039_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	39	0	1	1	1	H3957_039_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	39	0	1	1	1	H3957_039_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1273.41	33						1273.41	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	1	1	1	1	H3957_042_1	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	1	1	1	1	H3957_042_1	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	1	1	1	1	H3957_042_1	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	1	1	1	1	H3957_042_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	1	1	1	1	H3957_042_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.41	33						1094.41	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	2	1	1	1	H3957_042_2	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	2	1	1	1	H3957_042_2	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	2	1	1	1	H3957_042_2	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	2	1	1	1	H3957_042_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	2	1	1	1	H3957_042_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.41	33						1094.41	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	4	1	1	1	H3957_042_4	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	4	1	1	1	H3957_042_4	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	4	1	1	1	H3957_042_4	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	4	1	1	1	H3957_042_4	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	4	1	1	1	H3957_042_4	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.41	33						1094.41	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	5	1	1	1	H3957_042_5	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	5	1	1	1	H3957_042_5	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	5	1	1	1	H3957_042_5	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	5	1	1	1	H3957_042_5	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	42	5	1	1	1	H3957_042_5	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1094.41	33						1094.41	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	1	1	2	1	H3957_044_1	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	1	1	2	1	H3957_044_1	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	1	1	2	1	H3957_044_1	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	1	1	2	1	H3957_044_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	1	1	2	1	H3957_044_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1101.28	33						1101.28	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	2	1	2	1	H3957_044_2	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	2	1	2	1	H3957_044_2	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	2	1	2	1	H3957_044_2	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	2	1	2	1	H3957_044_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	44	2	1	2	1	H3957_044_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1101.28	33						1101.28	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	1	1	2	1	H3957_045_1	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	1	1	2	1	H3957_045_1	4	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	1	1	2	1	H3957_045_1	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	31		90				1	2			90				31		31	44		132																					110																44				44		1.42						1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	1	1	2	1	H3957_045_1	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	31		90				1	2			90				31		31	100		300																					250																100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	1	1	2	1	H3957_045_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1334.05	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	2	1	2	1	H3957_045_2	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	2	1	2	1	H3957_045_2	4	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	2	1	2	1	H3957_045_2	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	31		90				1	2			90				31		31	44		132																					110																44				44		1.42						1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	2	1	2	1	H3957_045_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	31		90				1	2			90				31		31	100		300																					250																100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	2	1	2	1	H3957_045_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1334.05	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	3	1	2	1	H3957_045_3	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	3	1	2	1	H3957_045_3	4	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	3	1	2	1	H3957_045_3	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	31		90				1	2			90				31		31	44		132																					110																44				44		1.42						1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	3	1	2	1	H3957_045_3	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	31		90				1	2			90				31		31	100		300																					250																100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	45	3	1	2	1	H3957_045_3	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1334.05	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	1	1	2	1	H3957_046_1	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	1	1	2	1	H3957_046_1	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	46	1	1	2	1	H3957_046_1	4	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	1	1	2	1	H3957_046_1	4	Generic	4	1	1	2	2	3	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	46	1	1	2	1	H3957_046_1	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	31		90				1	2			90				31		31	42		126																					105																42				42		1.35						1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	1	1	2	1	H3957_046_1	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	31		90				1	2			90				31		31	100		300																					250																100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	1	1	2	1	H3957_046_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1458.86	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	2	1	2	1	H3957_046_2	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	2	1	2	1	H3957_046_2	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	46	2	1	2	1	H3957_046_2	4	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	2	1	2	1	H3957_046_2	4	Generic	4	1	1	2	2	3	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	46	2	1	2	1	H3957_046_2	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	31		90				1	2			90				31		31	42		126																					105																42				42		1.35						1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	2	1	2	1	H3957_046_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	31		90				1	2			90				31		31	100		300																					250																100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	2	1	2	1	H3957_046_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1458.86	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	3	1	2	1	H3957_046_3	4	Preferred Generic	4	1	1	2	1	1	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	3	1	2	1	H3957_046_3	4	Preferred Generic	4	1	1	2	1	3	110		1	100		1	31		90				1	2			90				31		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	46	3	1	2	1	H3957_046_3	4	Generic	4	1	1	2	2	1	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	3	1	2	1	H3957_046_3	4	Generic	4	1	1	2	2	3	110		1	100		1	31		90				1	2			90				31		31	13		39																					32.5																13				13		0.42						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3957	46	3	1	2	1	H3957_046_3	4	Preferred Brand	4	11	1	2	3	1	110		1	100		1	31		90				1	2			90				31		31	42		126																					105																42				42		1.35						1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	3	1	2	1	H3957_046_3	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	31		90				1	2			90				31		31	100		300																					250																100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	46	3	1	2	1	H3957_046_3	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1458.86	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	1	1	1	1	H3957_047_1	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	1	1	1	1	H3957_047_1	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	1	1	1	1	H3957_047_1	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	1	1	1	1	H3957_047_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	1	1	1	1	H3957_047_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1080.85	33						1080.85	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	2	1	1	1	H3957_047_2	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	2	1	1	1	H3957_047_2	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								15		45					5		15													45						12				15				15			0.48	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	2	1	1	1	H3957_047_2	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	2	1	1	1	H3957_047_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						275				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3957	47	2	1	1	1	H3957_047_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1080.85	33						1080.85	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H3959	1	0	1	1	1	H3959_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	1	0	1	1	1	H3959_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	1	0	1	1	1	H3959_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	1	0	1	1	1	H3959_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	1	0	1	1	1	H3959_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	1	0	1	1	1	H3959_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	1	0	1	1	1	H3959_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											733.23	33						850.43	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	2	0	1	1	1	H3959_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	2	0	1	1	1	H3959_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	2	0	1	1	1	H3959_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	2	0	1	1	1	H3959_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	2	0	1	1	1	H3959_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	2	0	1	1	1	H3959_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	2	0	1	1	1	H3959_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											776.09	33						775.94	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	10	0	1	1	1	H3959_010_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	10	0	1	1	1	H3959_010_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	10	0	1	1	1	H3959_010_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	10	0	1	1	1	H3959_010_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	10	0	1	1	1	H3959_010_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	10	0	1	1	1	H3959_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	10	0	1	1	1	H3959_010_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											926.84	33						1044.02	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	11	0	1	1	1	H3959_011_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	11	0	1	1	1	H3959_011_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	11	0	1	1	1	H3959_011_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	11	0	1	1	1	H3959_011_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	11	0	1	1	1	H3959_011_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	11	0	1	1	1	H3959_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	11	0	1	1	1	H3959_011_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											722.3	33						749.29	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	32	0	1	1	1	H3959_032_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	32	0	1	1	1	H3959_032_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	32	0	1	1	1	H3959_032_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	32	0	1	1	1	H3959_032_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	32	0	1	1	1	H3959_032_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	32	0	1	1	1	H3959_032_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	32	0	1	1	1	H3959_032_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											872.02	33						863.13	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	33	0	1	1	1	H3959_033_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	33	0	1	1	1	H3959_033_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	33	0	1	1	1	H3959_033_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	33	0	1	1	1	H3959_033_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	33	0	1	1	1	H3959_033_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	33	0	1	1	1	H3959_033_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	33	0	1	1	1	H3959_033_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1018.34	33						1038.65	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	35	0	1	1	1	H3959_035_0	6	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	35	0	1	1	1	H3959_035_0	6	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	35	0	1	1	1	H3959_035_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	35	0	1	1	1	H3959_035_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	35	0	1	1	1	H3959_035_0	6	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				559.41	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	36	0	1	1	1	H3959_036_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	36	0	1	1	1	H3959_036_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	36	0	1	1	1	H3959_036_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	36	0	1	1	1	H3959_036_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	36	0	1	1	1	H3959_036_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				572.16	29																				29																		29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	37	0	1	1	1	H3959_037_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	37	0	1	1	1	H3959_037_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	37	0	1	1	1	H3959_037_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	37	0	1	1	1	H3959_037_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	37	0	1	1	1	H3959_037_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	37	0	1	1	1	H3959_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	37	0	1	1	1	H3959_037_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											698.69	33						675.85	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	39	0	1	1	1	H3959_039_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	39	0	1	1	1	H3959_039_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	39	0	1	1	1	H3959_039_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	39	0	1	1	1	H3959_039_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	39	0	1	1	1	H3959_039_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	39	0	1	1	1	H3959_039_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	39	0	1	1	1	H3959_039_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1013.78	33						965.54	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	45	0	1	1	1	H3959_045_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	45	0	1	1	1	H3959_045_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	45	0	1	1	1	H3959_045_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	45	0	1	1	1	H3959_045_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	45	0	1	1	1	H3959_045_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	45	0	1	1	1	H3959_045_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	45	0	1	1	1	H3959_045_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											811.88	33						762.38	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	46	0	1	1	1	H3959_046_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	46	0	1	1	1	H3959_046_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	46	0	1	1	1	H3959_046_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	46	0	1	1	1	H3959_046_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	46	0	1	1	1	H3959_046_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	46	0	1	1	1	H3959_046_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	46	0	1	1	1	H3959_046_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											938.07	33						979.18	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	47	0	1	1	1	H3959_047_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	47	0	1	1	1	H3959_047_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	47	0	1	1	1	H3959_047_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	47	0	1	1	1	H3959_047_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	47	0	1	1	1	H3959_047_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	47	0	1	1	1	H3959_047_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	47	0	1	1	1	H3959_047_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											939.44	33						963.5	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	49	0	1	1	1	H3959_049_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	49	0	1	1	1	H3959_049_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	49	0	1	1	1	H3959_049_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	49	0	1	1	1	H3959_049_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	49	0	1	1	1	H3959_049_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	49	0	1	1	1	H3959_049_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	49	0	1	1	1	H3959_049_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											758.21	33						781.12	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	51	0	1	1	1	H3959_051_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	51	0	1	1	1	H3959_051_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	51	0	1	1	1	H3959_051_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	51	0	1	1	1	H3959_051_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	51	0	1	1	1	H3959_051_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	51	0	1	1	1	H3959_051_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	51	0	1	1	1	H3959_051_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											849.6	33						875.89	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	52	0	1	1	1	H3959_052_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	52	0	1	1	1	H3959_052_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	52	0	1	1	1	H3959_052_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	52	0	1	1	1	H3959_052_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H3959	52	0	1	1	1	H3959_052_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	52	0	1	1	1	H3959_052_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3959	52	0	1	1	1	H3959_052_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											835.53	33						836.53	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H3962	1	0	1	1	1	H3962_001_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	10.5	14					0	0	0											7	10.5	14				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	1	0	1	1	1	H3962_001_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	10.5	14					0	0	0											7	10.5	14				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3962	1	0	1	1	1	H3962_001_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8	12	16					0	0	0											8	12	16				0	0	0					8			8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	1	0	1	1	1	H3962_001_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8	12	16					0	0	0											8	12	16				0	0	0					8			8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3962	1	0	1	1	1	H3962_001_0	3	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	70.5	94					40	60	80											47	70.5	94				40	60	80					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	1	0	1	1	1	H3962_001_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	150	200					93	139.5	186											100	150	200				93	139.5	186					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	1	0	1	1	1	H3962_001_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1006.8	33						1006.8	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	1	0	1	1	1	H3962_001_0	3	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	10.5	14					0	0	0											7	10.5	14				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	1	0	1	1	1	H3962_001_0	3	Select Care Drugs	4	1	1	2	6	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	10.5	14					0	0	0											7	10.5	14				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H3962	4	0	1	1	1	H3962_004_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	4	0	1	1	1	H3962_004_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					5	10	15											15	30	45				5	10	15					15			15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	4	0	1	1	1	H3962_004_0	3	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	4	0	1	1	1	H3962_004_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	4	0	1	1	1	H3962_004_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											966.65	33						966.65	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	4	0	1	1	1	H3962_004_0	3	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	7	0	1	1	1	H3962_007_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	7	0	1	1	1	H3962_007_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					5	10	15											15	30	45				5	10	15					15			15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	7	0	1	1	1	H3962_007_0	4	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	7	0	1	1	1	H3962_007_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	7	0	1	1	1	H3962_007_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											819.22	33						819.22	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	7	0	1	1	1	H3962_007_0	4	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	18	0	1	1	1	H3962_018_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					0	0	0											10	20	30				0	0	0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	18	0	1	1	1	H3962_018_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	18	0	1	1	1	H3962_018_0	4	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	18	0	1	1	1	H3962_018_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	18	0	1	1	1	H3962_018_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											738.61	33						738.61	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	18	0	1	1	1	H3962_018_0	4	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	19	0	1	1	1	H3962_019_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8	16	24					0	0	0											8	16	24				0	0	0					8			8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	19	0	1	1	1	H3962_019_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					5	10	15											15	30	45				5	10	15					15			15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	19	0	1	1	1	H3962_019_0	4	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	19	0	1	1	1	H3962_019_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	19	0	1	1	1	H3962_019_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											996.32	33						996.32	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	19	0	1	1	1	H3962_019_0	4	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	20	0	1	1	1	H3962_020_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					0	0	0											10	20	30				0	0	0					10			10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	20	0	1	1	1	H3962_020_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	20	0	1	1	1	H3962_020_0	3	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	20	0	1	1	1	H3962_020_0	3	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	20	0	1	1	1	H3962_020_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											776.75	33						776.75	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3962	20	0	1	1	1	H3962_020_0	3	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H3979	1	0	1	1	1	H3979_001_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3979	1	0	1	1	1	H3979_001_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H3979	1	0	1	1	1	H3979_001_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3979	1	0	1	1	1	H3979_001_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3979	1	0	1	1	1	H3979_001_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H3979	1	0	1	1	1	H3979_001_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	9	0	1	1	1	H4003_009_0	10	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	9	0	1	1	1	H4003_009_0	10	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4003	9	0	1	1	1	H4003_009_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	9	0	1	1	1	H4003_009_0	10	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4003	9	0	1	1	1	H4003_009_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	8		16																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	9	0	1	1	1	H4003_009_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	25		50																					50																25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	9	0	1	1	1	H4003_009_0	10	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				261.24	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	19	0	1	2	1	H4003_019_0	8	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	19	0	1	2	1	H4003_019_0	8	Preferred Generic	4	1	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		1
H4003	19	0	1	2	1	H4003_019_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	19	0	1	2	1	H4003_019_0	8	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4003	19	0	1	2	1	H4003_019_0	8	Preferred Brand	4	10	3	2	3	1	110		1	100		1	30		90				2	2			90				30		31	8		16																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	19	0	1	2	1	H4003_019_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	19	0	1	2	1	H4003_019_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				155.94	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	34	0	1	2	1	H4003_034_0	8	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	34	0	1	2	1	H4003_034_0	8	Preferred Generic	4	1	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		1
H4003	34	0	1	2	1	H4003_034_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	34	0	1	2	1	H4003_034_0	8	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4003	34	0	1	2	1	H4003_034_0	8	Preferred Brand	4	10	3	2	3	1	110		1	100		1	30		90				2	2			90				30		31	8		16																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	34	0	1	2	1	H4003_034_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	12		24																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	34	0	1	2	1	H4003_034_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				227.52	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	44	0	1	2	1	H4003_044_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	2		4																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	44	0	1	2	1	H4003_044_0	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	2		4																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4003	44	0	1	2	1	H4003_044_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	5		10																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	44	0	1	2	1	H4003_044_0	8	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	5		10																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4003	44	0	1	2	1	H4003_044_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	30		60																					60																30				30		1						0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	44	0	1	2	1	H4003_044_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	50		100																					100																50				50		1.67						1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	44	0	1	2	1	H4003_044_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				199.32	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	45	0	1	2	1	H4003_045_0	9	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	45	0	1	2	1	H4003_045_0	9	Preferred Generic	4	1	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		1
H4003	45	0	1	2	1	H4003_045_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	45	0	1	2	1	H4003_045_0	9	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4003	45	0	1	2	1	H4003_045_0	9	Preferred Brand	4	10	3	2	3	1	110		1	100		1	30		90				2	2			90				30		31	15		30																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	45	0	1	2	1	H4003_045_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	20		40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4003	45	0	1	2	1	H4003_045_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				210.82	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4004	56	0	1	2	1	H4004_056_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4004	56	0	1	2	1	H4004_056_0	10	Preferred Generic	4	1	3	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		1
H4004	56	0	1	2	1	H4004_056_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4004	56	0	1	2	1	H4004_056_0	10	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H4004	56	0	1	2	1	H4004_056_0	10	Preferred Brand	4	10	3	2	3	1	110		1	100		1	30		90				2	2			90				30		31	8		16																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4004	56	0	1	2	1	H4004_056_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	12		24																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4004	56	0	1	2	1	H4004_056_0	10	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				121.51	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4005	4	0	1	4	1	H4005_004_0	5	Preferred Generic	4	1	3	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4005	4	0	1	4	1	H4005_004_0	5	Preferred Generic	4	1	3	2	1	3		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H4005	4	0	1	4	1	H4005_004_0	5	Generic	4	1	3	2	2	1		110	1	100		1				30		90	1	2			90				30		31								8		16					0		0							0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4005	4	0	1	4	1	H4005_004_0	5	Generic	4	1	3	2	2	3		110	1	100		1				30		90	1	2			90				30		31								8		16					0		0							0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H4005	4	0	1	4	1	H4005_004_0	5	Preferred Brand	4	10	3	2	3	1		110	1	100		1				30		90	1	2			90				30		31								40		80					25		50							50																40				25			1.33	0.83				0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4005	4	0	1	4	1	H4005_004_0	5	Non-Preferred Brand	4	10	3	2	4	1		110	1	100		1				30		90	1	1			90				30		31								55		110					40		80							80																55				40			1.83	1.33				1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4005	4	0	1	4	1	H4005_004_0	5	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											33	33		33				33	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4005	4	0	1	4	1	H4005_004_0	5	Select Care Drugs	4	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4005	4	0	1	4	1	H4005_004_0	5	Select Care Drugs	4	11	1	2	6	3		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H4007	12	0	1	1	1	H4007_012_0	6	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	12	0	1	1	1	H4007_012_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	12	0	1	1	1	H4007_012_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				2	2				30		90	30		31	25		50																									25		75				25		50				25				25		0.83				0.83	0.83	0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	12	0	1	1	1	H4007_012_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				2	2				30		90	30		31	45		135																									45		135				45		125				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	12	0	1	1	1	H4007_012_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	12	0	1	1	1	H4007_012_0	6	Select Care Drugs	4	11	1	2	6	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	13	0	1	1	1	H4007_013_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	13	0	1	1	1	H4007_013_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	4		12																									4		12				4		0				4				4		0.13				0.13	0.13	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	13	0	1	1	1	H4007_013_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				2	2				30		90	30		31	35		105																									35		105				35		95				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	13	0	1	1	1	H4007_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				2	2				30		90	30		31	40		120																									40		120				40		110				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	13	0	1	1	1	H4007_013_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	13	0	1	1	1	H4007_013_0	4	Select Care Drugs	4	11	1	2	6	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	20	0	1	1	1	H4007_020_0	3	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				2	2				30		90	30		31	3		9																									3		9				3		0				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	20	0	1	1	1	H4007_020_0	3	Generic	4	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	6		18																									6		18				6		0				6				6		0.2				0.2	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	20	0	1	1	1	H4007_020_0	3	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				2	2				30		90	30		31	28		84																									28		84				28		74				28				28		0.93				0.93	0.93	0.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	20	0	1	1	1	H4007_020_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				2	2				30		90	30		31	58		174																									58		174				58		164				58				58		1.93				1.93	1.93	1.87	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	20	0	1	1	1	H4007_020_0	3	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4007	20	0	1	1	1	H4007_020_0	3	Select Care Drugs	4	11	1	2	6	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	8	0	1	4	1	H4036_008_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	8	0	1	4	1	H4036_008_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	8	0	1	4	1	H4036_008_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	8	0	1	4	1	H4036_008_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	8	0	1	4	1	H4036_008_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	8	0	1	4	1	H4036_008_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	8	0	1	4	1	H4036_008_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4036	9	0	1	4	1	H4036_009_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	9	0	1	4	1	H4036_009_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	9	0	1	4	1	H4036_009_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	9	0	1	4	1	H4036_009_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	9	0	1	4	1	H4036_009_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	9	0	1	4	1	H4036_009_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	9	0	1	4	1	H4036_009_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4036	10	1	1	4	1	H4036_010_1	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	1	1	4	1	H4036_010_1	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	1	1	4	1	H4036_010_1	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	1	1	4	1	H4036_010_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	1	1	4	1	H4036_010_1	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	1	1	4	1	H4036_010_1	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	1	1	4	1	H4036_010_1	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4036	10	2	1	4	1	H4036_010_2	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	2	1	4	1	H4036_010_2	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	2	1	4	1	H4036_010_2	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	2	1	4	1	H4036_010_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	2	1	4	1	H4036_010_2	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	2	1	4	1	H4036_010_2	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	10	2	1	4	1	H4036_010_2	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4036	17	0	1	4	1	H4036_017_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	17	0	1	4	1	H4036_017_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	17	0	1	4	1	H4036_017_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	17	0	1	4	1	H4036_017_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	17	0	1	4	1	H4036_017_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	17	0	1	4	1	H4036_017_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4036	17	0	1	4	1	H4036_017_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4140	1	0	1	2	1	H4140_001_0	8	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	1	0	1	2	1	H4140_001_0	8	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H4140	1	0	1	2	1	H4140_001_0	8	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	1	0	1	2	1	H4140_001_0	8	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4140	1	0	1	2	1	H4140_001_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	1	0	1	2	1	H4140_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	35	70	105																			35	70	105																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	1	0	1	2	1	H4140_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1064.48	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	2	0	1	2	1	H4140_002_0	8	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	2	0	1	2	1	H4140_002_0	8	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H4140	2	0	1	2	1	H4140_002_0	8	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	2	0	1	2	1	H4140_002_0	8	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4140	2	0	1	2	1	H4140_002_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	2	0	1	2	1	H4140_002_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	35	70	105																			35	70	105																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	2	0	1	2	1	H4140_002_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				634.97	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	3	0	1	2	1	H4140_003_0	8	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	3	0	1	2	1	H4140_003_0	8	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H4140	3	0	1	2	1	H4140_003_0	8	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	3	0	1	2	1	H4140_003_0	8	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4140	3	0	1	2	1	H4140_003_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	3	0	1	2	1	H4140_003_0	8	Preferred Brand	4	11	1	2	3	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H4140	3	0	1	2	1	H4140_003_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	40	80	120																			40	80	120																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	3	0	1	2	1	H4140_003_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				758.36	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	4	0	1	2	1	H4140_004_0	8	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	4	0	1	2	1	H4140_004_0	8	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H4140	4	0	1	2	1	H4140_004_0	8	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	4	0	1	2	1	H4140_004_0	8	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4140	4	0	1	2	1	H4140_004_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	4	0	1	2	1	H4140_004_0	8	Preferred Brand	4	11	1	2	3	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H4140	4	0	1	2	1	H4140_004_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	40	80	120																			40	80	120																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	4	0	1	2	1	H4140_004_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				647.99	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	5	0	1	2	1	H4140_005_0	8	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	5	0	1	2	1	H4140_005_0	8	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H4140	5	0	1	2	1	H4140_005_0	8	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	5	0	1	2	1	H4140_005_0	8	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				1	1	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4140	5	0	1	2	1	H4140_005_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	35	70	105																			35	70	105																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	5	0	1	2	1	H4140_005_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	1	30	60	90				30		31	90	180	270																			90	180	270																90				90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4140	5	0	1	2	1	H4140_005_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				943.6	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	3	0	1	1	1	H4141_003_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	3	0	1	1	1	H4141_003_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	3	0	1	1	1	H4141_003_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	3	0	1	1	1	H4141_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	3	0	1	1	1	H4141_003_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	15	0	1	1	1	H4141_015_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	15	0	1	1	1	H4141_015_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	15	0	1	1	1	H4141_015_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	15	0	1	1	1	H4141_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	15	0	1	1	1	H4141_015_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	3	1	1	1	H4141_017_3	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	3	1	1	1	H4141_017_3	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	3	1	1	1	H4141_017_3	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	3	1	1	1	H4141_017_3	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	3	1	1	1	H4141_017_3	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	4	1	1	1	H4141_017_4	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	4	1	1	1	H4141_017_4	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	4	1	1	1	H4141_017_4	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	4	1	1	1	H4141_017_4	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	17	4	1	1	1	H4141_017_4	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	1	1	1	1	H4141_019_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	1	1	1	1	H4141_019_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	1	1	1	1	H4141_019_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	1	1	1	1	H4141_019_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	1	1	1	1	H4141_019_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	2	1	1	1	H4141_019_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	2	1	1	1	H4141_019_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	2	1	1	1	H4141_019_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	2	1	1	1	H4141_019_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	19	2	1	1	1	H4141_019_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	20	0	1	1	1	H4141_020_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	20	0	1	1	1	H4141_020_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	20	0	1	1	1	H4141_020_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	20	0	1	1	1	H4141_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4141	20	0	1	1	1	H4141_020_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4152	5	0	1	1	1	H4152_005_0	7	Preferred Generic	4	1	1	2	1	1		111	1	101		1				30	60	90	1	2		60	90				30		31								11	22	33					3	6	9						0	0																11				3			0.37	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	5	0	1	1	1	H4152_005_0	7	Generic	4	1	1	2	2	1		111	1	101		1				30	60	90	1	2		60	90				30		31								14	28	42					6	12	18						0	0																14				6			0.47	0.2				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	5	0	1	1	1	H4152_005_0	7	Preferred Brand	4	11	1	2	3	1		111	1	101		1				30	60	90	1	2		60	90				30		31								47	94	141					47	94	141						94	117.5																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	5	0	1	1	1	H4152_005_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	1	101		1				30	60	90	1	2		60	90				30		31								100	200	300					100	200	300						200	250																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	5	0	1	1	1	H4152_005_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	7	0	1	2	1	H4152_007_0	7	Preferred Generic	4	1	1	2	1	1		111	1	101		1				30	60	90	1	2		60	90				30		31								11	22	33					3	6	9						0	0																11				3			0.37	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	7	0	1	2	1	H4152_007_0	7	Preferred Generic	4	1	1	2	1	3		111	1	101		1				30	60	90	1	2		60	90				30		31								11	22	33					3	6	9						0	0																11				3			0.37	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H4152	7	0	1	2	1	H4152_007_0	7	Generic	4	1	1	2	2	1		111	1	101		1				30	60	90	1	2		60	90				30		31								14	28	42					6	12	18						0	0																14				6			0.47	0.2				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	7	0	1	2	1	H4152_007_0	7	Generic	4	1	1	2	2	3		111	1	101		1				30	60	90	1	2		60	90				30		31								14	28	42					6	12	18						0	0																14				6			0.47	0.2				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H4152	7	0	1	2	1	H4152_007_0	7	Preferred Brand	4	11	1	2	3	1		111	1	101		1				30	60	90	1	2		60	90				30		31								47	94	141					47	94	141						94	117.5																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	7	0	1	2	1	H4152_007_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	1	101		1				30	60	90	1	2		60	90				30		31								100	200	300					100	200	300						200	250																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	7	0	1	2	1	H4152_007_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	13	0	1	1	1	H4152_013_0	7	Preferred Generic	4	1	1	2	1	1		111	1	101		1				30	60	90	1	2		60	90				30		31								9	18	27					1	2	3						0	0																9				1			0.3	0.03				0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	13	0	1	1	1	H4152_013_0	7	Generic	4	1	1	2	2	1		111	1	101		1				30	60	90	1	2		60	90				30		31								16	32	48					8	16	24						0	0																16				8			0.53	0.27				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	13	0	1	1	1	H4152_013_0	7	Preferred Brand	4	11	1	2	3	1		111	1	101		1				30	60	90	1	2		60	90				30		31								47	94	141					47	94	141						94	117.5																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	13	0	1	1	1	H4152_013_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	1	101		1				30	60	90	1	2		60	90				30		31								100	200	300					100	200	300						200	250																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	13	0	1	1	1	H4152_013_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	17	0	1	1	1	H4152_017_0	7	Preferred Generic	4	1	1	2	1	1		111	1	101		1				30	60	90	1	2		60	90				30		31								10	20	30					2	4	6						0	0																10				2			0.33	0.07				0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	17	0	1	1	1	H4152_017_0	7	Generic	4	1	1	2	2	1		111	1	101		1				30	60	90	1	2		60	90				30		31								17	34	51					9	18	27						0	0																17				9			0.57	0.3				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	17	0	1	1	1	H4152_017_0	7	Preferred Brand	4	11	1	2	3	1		111	1	101		1				30	60	90	1	2		60	90				30		31								47	94	141					47	94	141						94	117.5																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	17	0	1	1	1	H4152_017_0	7	Non-Preferred Brand	4	11	1	2	4	1		111	1	101		1				30	60	90	1	2		60	90				30		31								100	200	300					100	200	300						200	250																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	17	0	1	1	1	H4152_017_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	18	0	1	2	1	H4152_018_0	8	Preferred Generic	4	1	1	2	1	1		111	1	101		1				30	60	90	1	2		60	90				30		31								8	16	24					0	0	0						0	0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	18	0	1	2	1	H4152_018_0	8	Generic	4	1	1	2	2	1		111	1	101		1				30	60	90	1	2		60	90				30		31								12	24	36					4	8	12						0	0																12				4			0.4	0.13				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	18	0	1	2	1	H4152_018_0	8	Preferred Brand	4	11	1	2	3	1		111	1	101		1				30	60	90	1	2		60	90				30		31								47	94	141					47	94	141						94	117.5																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	18	0	1	2	1	H4152_018_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1	101		1				30	60	90	1	2		60	90				30		31								100	200	300					100	200	300						200	250																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	18	0	1	2	1	H4152_018_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	20	0	1	2	1	H4152_020_0	6	Preferred Generic	4	1	1	2	1	1		111	1	101		1				30	60	90	1	2		60	90				30		31								8	16	24					0	0	0						0	0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	20	0	1	2	1	H4152_020_0	6	Generic	4	1	1	2	2	1		111	1	101		1				30	60	90	1	2		60	90				30		31								16	32	48					0	0	0						0	0																16				0			0.53	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	20	0	1	2	1	H4152_020_0	6	Preferred Brand	4	11	1	2	3	1		111	1	101		1				30	60	90	1	2		60	90				30		31								47	94	141					47	94	141						94	117.5																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	20	0	1	2	1	H4152_020_0	6	Non-Preferred Brand	4	11	1	2	4	1		111	1	101		1				30	60	90	1	2		60	90				30		31								100	200	300					100	200	300						200	250																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4152	20	0	1	2	1	H4152_020_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4172	2	0	1	1	1	H4172_002_0	5	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4	8	12																																						4			4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4172	2	0	1	1	1	H4172_002_0	5	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4172	2	0	1	1	1	H4172_002_0	5	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4172	2	0	1	1	1	H4172_002_0	5	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4172	2	0	1	1	1	H4172_002_0	5	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31				2200	33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4198	3	0	1	1	1	H4198_003_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	3	0	1	1	1	H4198_003_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	24	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	3	0	1	1	1	H4198_003_0	6	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	3	0	1	1	1	H4198_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	3	0	1	1	1	H4198_003_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				2360.15	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	5	0	1	1	1	H4198_005_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	5	0	1	1	1	H4198_005_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	13	26	39																			13	26	26																13				13		0.43			0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	5	0	1	1	1	H4198_005_0	5	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	5	0	1	1	1	H4198_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	90	180	270																			90	180	180																90				90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4198	5	0	1	1	1	H4198_005_0	5	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				1907.68	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	1	1	9	4	H4213_017_1	7	Preferred Generic	3	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		25					3		7.5					3		7.5																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	1	1	9	4	H4213_017_1	7	Generic	3	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					13		32.5					13		32.5																20				13			0.67	0.43	0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	1	1	9	4	H4213_017_1	7	Preferred Brand	3	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		117.5					40		100					40		100																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	1	1	9	4	H4213_017_1	7	Non-Preferred Drug	3	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											67	50		50				54	48		48				48		48															50			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	1	1	9	4	H4213_017_1	7	Specialty Tier	3	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	27		27				1	27		27				27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	5	1	9	4	H4213_017_5	7	Preferred Generic	3	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		25					3		7.5					3		7.5																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	5	1	9	4	H4213_017_5	7	Generic	3	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					13		32.5					13		32.5																20				13			0.67	0.43	0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	5	1	9	4	H4213_017_5	7	Preferred Brand	3	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		117.5					40		100					40		100																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	5	1	9	4	H4213_017_5	7	Non-Preferred Drug	3	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											67	50		50				54	48		48				48		48															50			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	5	1	9	4	H4213_017_5	7	Specialty Tier	3	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	27		27				1	27		27				27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	6	1	9	4	H4213_017_6	7	Preferred Generic	3	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		25					3		7.5					3		7.5																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	6	1	9	4	H4213_017_6	7	Generic	3	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					13		32.5					13		32.5																20				13			0.67	0.43	0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	6	1	9	4	H4213_017_6	7	Preferred Brand	3	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		117.5					40		100					40		100																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	6	1	9	4	H4213_017_6	7	Non-Preferred Drug	3	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											67	50		50				54	48		48				48		48															50			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4213	17	6	1	9	4	H4213_017_6	7	Specialty Tier	3	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	27		27				1	27		27				27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4227	1	0	1	1	1	H4227_001_0	5	Generic	2	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	6	12	18																					18																6				6		0.2						0.19	"Generic, Brand"												
H4227	1	0	1	1	1	H4227_001_0	5	Brand	2	10	1	1	2	1	111		1	100		1	30	60	90				1	2			90				30		31				92.28	25	25	25																				25															25			25								"Generic, Brand"												
H4227	2	0	1	1	1	H4227_002_0	5	Generic	2	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	6	12	18																					18																6				6		0.2						0.19	"Generic, Brand"												
H4227	2	0	1	1	1	H4227_002_0	5	Brand	2	10	1	1	2	1	111		1	100		1	30	60	90				1	2			90				30		31				90.79	25	25	25																				25															25			25								"Generic, Brand"												
H4236	1	0	1	1	1	H4236_001_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	1	0	1	1	1	H4236_001_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	1	0	1	1	1	H4236_001_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	1	0	1	1	1	H4236_001_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	1	0	1	1	1	H4236_001_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	2	0	1	1	1	H4236_002_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	2	0	1	1	1	H4236_002_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	2	0	1	1	1	H4236_002_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	2	0	1	1	1	H4236_002_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	2	0	1	1	1	H4236_002_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	3	0	1	1	1	H4236_003_0	9	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	3	0	1	1	1	H4236_003_0	9	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	3	0	1	1	1	H4236_003_0	9	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	3	0	1	1	1	H4236_003_0	9	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4236	3	0	1	1	1	H4236_003_0	9	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4279	1	0	1	1	1	H4279_001_0	11	Preferred Generic	2	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								9		27					2		4							4																9				9			0.3	0.07				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4279	1	0	1	1	1	H4279_001_0	11	Generic	2	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								15		45					8		16							16																15				15			0.5	0.27				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4279	1	0	1	1	1	H4279_001_0	11	Preferred Brand	2	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								17		51					10		25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4279	1	0	1	1	1	H4279_001_0	11	Non-Preferred Drug	2	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											57.57	46		46				62.56	46		46						46															46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4279	1	0	1	1	1	H4279_001_0	11	Specialty Tier	2	11	1	1	5	1		10	1	10		1				30					30						30		31											397.12	25						479.73	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	1	0	1	1	1	H4346_001_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	1	0	1	1	1	H4346_001_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	1	0	1	1	1	H4346_001_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	1	0	1	1	1	H4346_001_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	1	0	1	1	1	H4346_001_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	1	0	1	1	1	H4346_001_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	1	0	1	1	1	H4346_001_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	1	0	1	1	1	H4346_001_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	1	0	1	1	1	H4346_001_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H4346	5	0	1	1	1	H4346_005_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	5	0	1	1	1	H4346_005_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	5	0	1	1	1	H4346_005_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	5	0	1	1	1	H4346_005_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	5	0	1	1	1	H4346_005_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	5	0	1	1	1	H4346_005_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	5	0	1	1	1	H4346_005_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	5	0	1	1	1	H4346_005_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	5	0	1	1	1	H4346_005_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H4346	6	0	1	1	1	H4346_006_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	6	0	1	1	1	H4346_006_0	11	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	6	0	1	1	1	H4346_006_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	6	0	1	1	1	H4346_006_0	11	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	6	0	1	1	1	H4346_006_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	6	0	1	1	1	H4346_006_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	6	0	1	1	1	H4346_006_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	6	0	1	1	1	H4346_006_0	11	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	6	0	1	1	1	H4346_006_0	11	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H4346	8	0	1	1	1	H4346_008_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	8	0	1	1	1	H4346_008_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	8	0	1	1	1	H4346_008_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	8	0	1	1	1	H4346_008_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	8	0	1	1	1	H4346_008_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	8	0	1	1	1	H4346_008_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	8	0	1	1	1	H4346_008_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	8	0	1	1	1	H4346_008_0	9	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	8	0	1	1	1	H4346_008_0	9	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H4346	9	0	1	1	1	H4346_009_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	9	0	1	1	1	H4346_009_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15.5	31	46.5					10.5	21	31.5					10.5	21	21																15.5				15.5			0.52	0.35	0.35			0.46	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	9	0	1	1	1	H4346_009_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	9	0	1	1	1	H4346_009_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					90	180	270					90	180	180																95				95			3.17	3	3			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	9	0	1	1	1	H4346_009_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	9	0	1	1	1	H4346_009_0	8	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					10	20	30					10	20	20																10				10			0.33	0.33	0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	10	0	1	1	1	H4346_010_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	10	0	1	1	1	H4346_010_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	10	0	1	1	1	H4346_010_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	10	0	1	1	1	H4346_010_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	10	0	1	1	1	H4346_010_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	10	0	1	1	1	H4346_010_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	10	0	1	1	1	H4346_010_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	10	0	1	1	1	H4346_010_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	10	0	1	1	1	H4346_010_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H4346	11	0	1	1	1	H4346_011_0	8	Preferred Generic	4	1	1	1	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34				1.36	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	11	0	1	1	1	H4346_011_0	8	Generic	4	1	1	1	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				5.06	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	11	0	1	1	1	H4346_011_0	8	Preferred Brand	4	11	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				60.7	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	11	0	1	1	1	H4346_011_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				52.55	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	11	0	1	1	1	H4346_011_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	11	0	1	1	1	H4346_011_0	8	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	11	0	1	1	1	H4346_011_0	8	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	12	0	1	1	1	H4346_012_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	12	0	1	1	1	H4346_012_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	24	24																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	12	0	1	1	1	H4346_012_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	12	0	1	1	1	H4346_012_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	12	0	1	1	1	H4346_012_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	12	0	1	1	1	H4346_012_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	12	0	1	1	1	H4346_012_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	13	0	1	1	1	H4346_013_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	13	0	1	1	1	H4346_013_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	24	24																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	13	0	1	1	1	H4346_013_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	13	0	1	1	1	H4346_013_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	13	0	1	1	1	H4346_013_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	13	0	1	1	1	H4346_013_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	13	0	1	1	1	H4346_013_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	14	0	1	1	1	H4346_014_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	14	0	1	1	1	H4346_014_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	14	0	1	1	1	H4346_014_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	12	12																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	14	0	1	1	1	H4346_014_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								36	72	108					36	72	108					36	108	108																36				36			1.2	1.2	1.2			1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	14	0	1	1	1	H4346_014_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	14	0	1	1	1	H4346_014_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	14	0	1	1	1	H4346_014_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	14	0	1	1	1	H4346_014_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	17	0	1	1	1	H4346_017_0	9	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	17	0	1	1	1	H4346_017_0	9	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H4346	17	0	1	1	1	H4346_017_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	17	0	1	1	1	H4346_017_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	17	0	1	1	1	H4346_017_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	17	0	1	1	1	H4346_017_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	18	0	1	1	1	H4346_018_0	9	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	18	0	1	1	1	H4346_018_0	9	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H4346	18	0	1	1	1	H4346_018_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	18	0	1	1	1	H4346_018_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	18	0	1	1	1	H4346_018_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	18	0	1	1	1	H4346_018_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4346	19	0	1	1	1	H4346_019_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	19	0	1	1	1	H4346_019_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	24	24																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	19	0	1	1	1	H4346_019_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	19	0	1	1	1	H4346_019_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	19	0	1	1	1	H4346_019_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	19	0	1	1	1	H4346_019_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	19	0	1	1	1	H4346_019_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	22	0	1	1	1	H4346_022_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	22	0	1	1	1	H4346_022_0	10	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	22	0	1	1	1	H4346_022_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	22	0	1	1	1	H4346_022_0	10	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12.5	25	37.5					7.5	15	22.5					7.5	15	15																12.5				12.5			0.42	0.25	0.25			0.37	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	22	0	1	1	1	H4346_022_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	80	80																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	22	0	1	1	1	H4346_022_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								95	190	285					85	170	255					85	170	170																95				95			3.17	2.83	2.83			2.79	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	22	0	1	1	1	H4346_022_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	22	0	1	1	1	H4346_022_0	10	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	22	0	1	1	1	H4346_022_0	10	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H4346	23	0	1	1	1	H4346_023_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	23	0	1	1	1	H4346_023_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	23	0	1	1	1	H4346_023_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	23	0	1	1	1	H4346_023_0	10	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4346	23	0	1	1	1	H4346_023_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	23	0	1	1	1	H4346_023_0	10	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	23	0	1	1	1	H4346_023_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	23	0	1	1	1	H4346_023_0	10	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4346	23	0	1	1	1	H4346_023_0	10	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H4407	26	0	1	1	1	H4407_026_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	4											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	26	0	1	1	1	H4407_026_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	45					10	20	20											15	30	45				10	20	0				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	26	0	1	1	1	H4407_026_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	26	0	1	1	1	H4407_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	26	0	1	1	1	H4407_026_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											884.05	33						825.58	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	27	0	1	1	1	H4407_027_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	27	0	1	1	1	H4407_027_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	27	0	1	1	1	H4407_027_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	27	0	1	1	1	H4407_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4407	27	0	1	1	1	H4407_027_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											895.76	33						845.63	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	22	0	1	1	1	H4461_022_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	22	0	1	1	1	H4461_022_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	22	0	1	1	1	H4461_022_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	22	0	1	1	1	H4461_022_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	22	0	1	1	1	H4461_022_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	25	0	1	1	1	H4461_025_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	25	0	1	1	1	H4461_025_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	25	0	1	1	1	H4461_025_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	25	0	1	1	1	H4461_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	25	0	1	1	1	H4461_025_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	29	0	1	1	1	H4461_029_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	29	0	1	1	1	H4461_029_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	29	0	1	1	1	H4461_029_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	29	0	1	1	1	H4461_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	29	0	1	1	1	H4461_029_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	1	1	1	1	H4461_030_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	1	1	1	1	H4461_030_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	1	1	1	1	H4461_030_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	1	1	1	1	H4461_030_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	1	1	1	1	H4461_030_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	2	1	1	1	H4461_030_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	2	1	1	1	H4461_030_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	2	1	1	1	H4461_030_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	2	1	1	1	H4461_030_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	2	1	1	1	H4461_030_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	3	1	1	1	H4461_030_3	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	3	1	1	1	H4461_030_3	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	3	1	1	1	H4461_030_3	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	3	1	1	1	H4461_030_3	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	30	3	1	1	1	H4461_030_3	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	1	1	1	1	H4461_031_1	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	1	1	1	1	H4461_031_1	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	1	1	1	1	H4461_031_1	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	1	1	1	1	H4461_031_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	1	1	1	1	H4461_031_1	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	2	1	1	1	H4461_031_2	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	2	1	1	1	H4461_031_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	2	1	1	1	H4461_031_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	2	1	1	1	H4461_031_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	2	1	1	1	H4461_031_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	3	1	1	1	H4461_031_3	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	3	1	1	1	H4461_031_3	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	3	1	1	1	H4461_031_3	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	3	1	1	1	H4461_031_3	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	31	3	1	1	1	H4461_031_3	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	34	0	1	1	1	H4461_034_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	34	0	1	1	1	H4461_034_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	34	0	1	1	1	H4461_034_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	34	0	1	1	1	H4461_034_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	34	0	1	1	1	H4461_034_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	35	0	1	1	1	H4461_035_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	35	0	1	1	1	H4461_035_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	35	0	1	1	1	H4461_035_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	35	0	1	1	1	H4461_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	35	0	1	1	1	H4461_035_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	36	0	1	1	1	H4461_036_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	36	0	1	1	1	H4461_036_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	36	0	1	1	1	H4461_036_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	36	0	1	1	1	H4461_036_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4461	36	0	1	1	1	H4461_036_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	1	1	4	1	H4497_001_1	13	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	1	1	4	1	H4497_001_1	13	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	1	1	1	4	1	H4497_001_1	13	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	1	1	4	1	H4497_001_1	13	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	1	1	1	4	1	H4497_001_1	13	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	1	1	4	1	H4497_001_1	13	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											66.16	50		50				51.3	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	1	1	4	1	H4497_001_1	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	2	1	4	1	H4497_001_2	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	2	1	4	1	H4497_001_2	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	1	2	1	4	1	H4497_001_2	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	2	1	4	1	H4497_001_2	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	1	2	1	4	1	H4497_001_2	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	2	1	4	1	H4497_001_2	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											66.16	50		50				51.3	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	1	2	1	4	1	H4497_001_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	1	1	4	1	H4497_002_1	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	1	1	4	1	H4497_002_1	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	2	1	1	4	1	H4497_002_1	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	1	1	4	1	H4497_002_1	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	2	1	1	4	1	H4497_002_1	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	1	1	4	1	H4497_002_1	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											51.65	50		50				38.11	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	1	1	4	1	H4497_002_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	2	1	4	1	H4497_002_2	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	2	1	4	1	H4497_002_2	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	2	2	1	4	1	H4497_002_2	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	2	1	4	1	H4497_002_2	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	2	2	1	4	1	H4497_002_2	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	2	1	4	1	H4497_002_2	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											51.65	50		50				38.11	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	2	2	1	4	1	H4497_002_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	1	1	4	1	H4497_003_1	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	1	1	4	1	H4497_003_1	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	3	1	1	4	1	H4497_003_1	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	1	1	4	1	H4497_003_1	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	3	1	1	4	1	H4497_003_1	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	1	1	4	1	H4497_003_1	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											59.12	50		50				41.94	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	1	1	4	1	H4497_003_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	2	1	4	1	H4497_003_2	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	2	1	4	1	H4497_003_2	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	3	2	1	4	1	H4497_003_2	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	2	1	4	1	H4497_003_2	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4497	3	2	1	4	1	H4497_003_2	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	2	1	4	1	H4497_003_2	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											59.12	50		50				41.94	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4497	3	2	1	4	1	H4497_003_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	3	0	1	1	1	H4506_003_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	3	0	1	1	1	H4506_003_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4506	3	0	1	1	1	H4506_003_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		12.5																									5		12.5				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	3	0	1	1	1	H4506_003_0	5	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	5		12.5																									5		12.5				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4506	3	0	1	1	1	H4506_003_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		100																									40		100				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	3	0	1	1	1	H4506_003_0	5	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	40		100																									40		100				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H4506	3	0	1	1	1	H4506_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	80		200																									80		200				80		160				80				80		2.67				2.67	2.67	2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	3	0	1	1	1	H4506_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	29	0	1	2	1	H4506_029_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	29	0	1	2	1	H4506_029_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4506	29	0	1	2	1	H4506_029_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		12.5																									5		12.5				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	29	0	1	2	1	H4506_029_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	40		100																									40		100				40		80				40				40		1.33				1.33	1.33	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	29	0	1	2	1	H4506_029_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				68.43	35		35																								35		35				35		35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4506	29	0	1	2	1	H4506_029_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					28																										28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	25	0	1	1	1	H4513_025_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	5					0	0	0											5	10	5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	25	0	1	1	1	H4513_025_0	5	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	5					0	0	0											5	10	5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	25	0	1	1	1	H4513_025_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	9					4	8	4											9	18	9				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	25	0	1	1	1	H4513_025_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	90					40	80	80											45	90	90				40	80	80				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	25	0	1	1	1	H4513_025_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	170					80	160	160											85	170	170				80	160	160				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	25	0	1	1	1	H4513_025_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											971.68	33						854.32	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	26	0	1	1	1	H4513_026_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	20					3	6	7.5											8	16	20				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	26	0	1	1	1	H4513_026_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	32.5					8	16	20											13	26	32.5				0	0	0				13				13			0.43	0.27		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	26	0	1	1	1	H4513_026_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								40	80	120					35	70	105											40	80	120				35	70	105				40				40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	26	0	1	1	1	H4513_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								75	150	225					70	140	210											75	150	225				70	140	210				75				75			2.5	2.33		2.5	2.33	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	26	0	1	1	1	H4513_026_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											965.92	33						766.2	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	28	0	1	1	1	H4513_028_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	20					3	6	7.5											8	16	20				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	28	0	1	1	1	H4513_028_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	32.5					8	16	20											13	26	32.5				0	0	0				13				13			0.43	0.27		0.43	0	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	28	0	1	1	1	H4513_028_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								40	80	120					35	70	105											40	80	120				35	70	105				40				40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	28	0	1	1	1	H4513_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								75	150	225					70	140	210											75	150	225				70	140	210				75				75			2.5	2.33		2.5	2.33	2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	28	0	1	1	1	H4513_028_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											994.06	33						814.1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	30	0	1	1	1	H4513_030_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					3	6	6											10	20	20				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	30	0	1	1	1	H4513_030_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					3	6	6											10	20	20				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	30	0	1	1	1	H4513_030_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					12	24	24											20	40	40				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	30	0	1	1	1	H4513_030_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					12	24	24											20	40	40				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	30	0	1	1	1	H4513_030_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	30	0	1	1	1	H4513_030_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.59	46	46	46				79.65	46	46	46										46	46	46				46	46	46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	30	0	1	1	1	H4513_030_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											906.52	29						811.06	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	36	0	1	2	1	H4513_036_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	36	0	1	2	1	H4513_036_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	36	0	1	2	1	H4513_036_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	36	0	1	2	1	H4513_036_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	36	0	1	2	1	H4513_036_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	36	0	1	2	1	H4513_036_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.41	49	49	49				80.54	49	49	49										49	49	49				49	49	49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	36	0	1	2	1	H4513_036_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											876.96	29						797.18	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	37	0	1	1	1	H4513_037_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					0	0	0											10	20	20				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	37	0	1	1	1	H4513_037_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					0	0	0											10	20	20				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	37	0	1	1	1	H4513_037_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					10	20	20											20	40	40				10	20	0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	37	0	1	1	1	H4513_037_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	40					10	20	20											20	40	40				10	20	0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	37	0	1	1	1	H4513_037_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	37	0	1	1	1	H4513_037_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											97.55	40	40	40				84.92	40	40	40										40	40	40				40	40	40			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	37	0	1	1	1	H4513_037_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1071.53	33						917.49	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	38	0	1	1	1	H4513_038_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	38	0	1	1	1	H4513_038_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	38	0	1	1	1	H4513_038_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	38	0	1	1	1	H4513_038_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	38	0	1	1	1	H4513_038_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	38	0	1	1	1	H4513_038_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											86.16	50	50	50				71.11	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	38	0	1	1	1	H4513_038_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											835.37	28						689.43	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	42	0	1	1	1	H4513_042_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	42	0	1	1	1	H4513_042_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	42	0	1	1	1	H4513_042_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	42	0	1	1	1	H4513_042_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	42	0	1	1	1	H4513_042_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	42	0	1	1	1	H4513_042_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											97.42	43	43	43				87.18	43	43	43										43	43	43				43	43	43			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	42	0	1	1	1	H4513_042_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1143.4	33						1030.44	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	43	0	1	1	1	H4513_043_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	43	0	1	1	1	H4513_043_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	43	0	1	1	1	H4513_043_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	43	0	1	1	1	H4513_043_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	43	0	1	1	1	H4513_043_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	43	0	1	1	1	H4513_043_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.66	42	42	42				82.47	42	42	42										42	42	42				42	42	42			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	43	0	1	1	1	H4513_043_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1021.51	33						934.08	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	1	1	1	1	H4513_046_1	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								9	18	27					2	4	4											9	18	27				2	4	0				9				9			0.3	0.07		0.3	0.07	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	1	1	1	1	H4513_046_1	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	45					8	16	16											15	30	45				8	16	0				15				15			0.5	0.27		0.5	0.27	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	1	1	1	1	H4513_046_1	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	1	1	1	1	H4513_046_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											88.05	50	50	50				76.24	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	1	1	1	1	H4513_046_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											826.31	29						714.35	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	2	1	1	1	H4513_046_2	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								9	18	27					2	4	4											9	18	27				2	4	0				9				9			0.3	0.07		0.3	0.07	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	2	1	1	1	H4513_046_2	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	45					8	16	16											15	30	45				8	16	0				15				15			0.5	0.27		0.5	0.27	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	2	1	1	1	H4513_046_2	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	2	1	1	1	H4513_046_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											88.05	50	50	50				76.24	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	46	2	1	1	1	H4513_046_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											826.31	29						714.35	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	47	0	1	1	1	H4513_047_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	47	0	1	1	1	H4513_047_0	5	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	47	0	1	1	1	H4513_047_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	47	0	1	1	1	H4513_047_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	47	0	1	1	1	H4513_047_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1008.85	33						880.61	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	48	0	1	1	1	H4513_048_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	48	0	1	1	1	H4513_048_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	48	0	1	1	1	H4513_048_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	48	0	1	1	1	H4513_048_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	48	0	1	1	1	H4513_048_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											934.08	33						783.97	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	1	1	1	1	H4513_049_1	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	1	1	1	1	H4513_049_1	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	49	1	1	1	1	H4513_049_1	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	1	1	1	1	H4513_049_1	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	49	1	1	1	1	H4513_049_1	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	1	1	1	1	H4513_049_1	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.26	42	42	42				85.1	42	42	42										42	42	42				42	42	42			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	1	1	1	1	H4513_049_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1039.99	33						953.95	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	2	1	1	1	H4513_049_2	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	2	1	1	1	H4513_049_2	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	49	2	1	1	1	H4513_049_2	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	2	1	1	1	H4513_049_2	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					12	24	24											20	40	60				12	24	0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	49	2	1	1	1	H4513_049_2	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	2	1	1	1	H4513_049_2	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.26	42	42	42				85.1	42	42	42										42	42	42				42	42	42			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	49	2	1	1	1	H4513_049_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1039.99	33						953.95	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	50	0	1	1	1	H4513_050_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	50	0	1	1	1	H4513_050_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	50	0	1	1	1	H4513_050_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	50	0	1	1	1	H4513_050_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	50	0	1	1	1	H4513_050_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	50	0	1	1	1	H4513_050_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.43	50	50	50				76.73	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	50	0	1	1	1	H4513_050_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											827.48	28						748.78	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	51	0	1	1	1	H4513_051_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	51	0	1	1	1	H4513_051_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	51	0	1	1	1	H4513_051_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	51	0	1	1	1	H4513_051_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	51	0	1	1	1	H4513_051_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	51	0	1	1	1	H4513_051_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.43	50	50	50				76.73	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	51	0	1	1	1	H4513_051_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											827.48	28						748.78	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	52	0	1	1	1	H4513_052_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	52	0	1	1	1	H4513_052_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					3	6	6											10	20	30				3	6	0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	52	0	1	1	1	H4513_052_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	52	0	1	1	1	H4513_052_0	4	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					15	30	30											20	40	60				15	30	0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4513	52	0	1	1	1	H4513_052_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	52	0	1	1	1	H4513_052_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.43	50	50	50				76.73	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	52	0	1	1	1	H4513_052_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											827.48	28						748.78	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	54	0	1	1	1	H4513_054_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	4											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	54	0	1	1	1	H4513_054_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					8	16	16											13	26	39				8	16	0				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	54	0	1	1	1	H4513_054_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	54	0	1	1	1	H4513_054_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	54	0	1	1	1	H4513_054_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											934.08	33						783.97	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	57	0	1	1	1	H4513_057_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	4											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	57	0	1	1	1	H4513_057_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								13	26	39					8	16	16											13	26	39				8	16	0				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	57	0	1	1	1	H4513_057_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	57	0	1	1	1	H4513_057_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4513	57	0	1	1	1	H4513_057_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1008.85	33						880.61	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4514	7	0	1	1	1	H4514_007_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4514	7	0	1	1	1	H4514_007_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4514	7	0	1	1	1	H4514_007_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4514	7	0	1	1	1	H4514_007_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4514	7	0	1	1	1	H4514_007_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				703	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4523	1	0	1	1	1	H4523_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	1	0	1	1	1	H4523_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	1	0	1	1	1	H4523_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	1	0	1	1	1	H4523_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	1	0	1	1	1	H4523_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	1	0	1	1	1	H4523_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	1	0	1	1	1	H4523_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											587.5	28						581.21	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	15	0	1	1	1	H4523_015_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	15	0	1	1	1	H4523_015_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	15	0	1	1	1	H4523_015_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	15	0	1	1	1	H4523_015_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	15	0	1	1	1	H4523_015_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	15	0	1	1	1	H4523_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	15	0	1	1	1	H4523_015_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											642.59	28						587.21	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	20	0	1	1	1	H4523_020_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	20	0	1	1	1	H4523_020_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	20	0	1	1	1	H4523_020_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	20	0	1	1	1	H4523_020_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	20	0	1	1	1	H4523_020_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	20	0	1	1	1	H4523_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	20	0	1	1	1	H4523_020_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											765.58	28						751.79	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	21	0	1	1	1	H4523_021_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	21	0	1	1	1	H4523_021_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	21	0	1	1	1	H4523_021_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	21	0	1	1	1	H4523_021_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	21	0	1	1	1	H4523_021_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	21	0	1	1	1	H4523_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	21	0	1	1	1	H4523_021_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											686.32	28						659.46	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	24	0	1	1	1	H4523_024_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	24	0	1	1	1	H4523_024_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	24	0	1	1	1	H4523_024_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	24	0	1	1	1	H4523_024_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4523	24	0	1	1	1	H4523_024_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	24	0	1	1	1	H4523_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4523	24	0	1	1	1	H4523_024_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											663.12	28						628.73	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4527	1	0	1	1	1	H4527_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	1	0	1	1	1	H4527_001_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	1	0	1	1	1	H4527_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	1	0	1	1	1	H4527_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	1	0	1	1	1	H4527_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				890	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	2	0	1	1	1	H4527_002_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	2	0	1	1	1	H4527_002_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	2	0	1	1	1	H4527_002_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	2	0	1	1	1	H4527_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	2	0	1	1	1	H4527_002_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				842	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	5	0	1	1	1	H4527_005_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	5	0	1	1	1	H4527_005_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	5	0	1	1	1	H4527_005_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	5	0	1	1	1	H4527_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	5	0	1	1	1	H4527_005_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				709	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	13	0	1	1	1	H4527_013_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	13	0	1	1	1	H4527_013_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	13	0	1	1	1	H4527_013_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	13	0	1	1	1	H4527_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	13	0	1	1	1	H4527_013_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				707	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	15	0	1	1	1	H4527_015_0	3	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		100				2	2			100				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	15	0	1	1	1	H4527_015_0	3	Generic	4	1	1	1	2	1	110		1	100		1	30		100				2	2			100				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	15	0	1	1	1	H4527_015_0	3	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		100				2	2			100				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	15	0	1	1	1	H4527_015_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		100				2	2			100				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	15	0	1	1	1	H4527_015_0	3	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		100				2	2			100				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	37	0	1	2	1	H4527_037_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	37	0	1	2	1	H4527_037_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	37	0	1	2	1	H4527_037_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	37	0	1	2	1	H4527_037_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	37	0	1	2	1	H4527_037_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				725	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	38	0	1	2	1	H4527_038_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	38	0	1	2	1	H4527_038_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	38	0	1	2	1	H4527_038_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	38	0	1	2	1	H4527_038_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	38	0	1	2	1	H4527_038_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				757	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	39	0	1	1	1	H4527_039_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	39	0	1	1	1	H4527_039_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	39	0	1	1	1	H4527_039_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	39	0	1	1	1	H4527_039_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	39	0	1	1	1	H4527_039_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						75				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	39	0	1	1	1	H4527_039_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	39	0	1	1	1	H4527_039_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				664	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	40	0	1	1	1	H4527_040_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	40	0	1	1	1	H4527_040_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	40	0	1	1	1	H4527_040_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	40	0	1	1	1	H4527_040_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	40	0	1	1	1	H4527_040_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						75				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	40	0	1	1	1	H4527_040_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	40	0	1	1	1	H4527_040_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				664	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	41	0	1	1	1	H4527_041_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	41	0	1	1	1	H4527_041_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	41	0	1	1	1	H4527_041_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	41	0	1	1	1	H4527_041_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	41	0	1	1	1	H4527_041_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						75				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	41	0	1	1	1	H4527_041_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	41	0	1	1	1	H4527_041_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				664	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	42	0	1	1	1	H4527_042_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	42	0	1	1	1	H4527_042_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	42	0	1	1	1	H4527_042_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	42	0	1	1	1	H4527_042_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4527	42	0	1	1	1	H4527_042_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						75				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	42	0	1	1	1	H4527_042_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4527	42	0	1	1	1	H4527_042_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				664	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	10	0	1	1	1	H4590_010_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	10	0	1	1	1	H4590_010_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4590	10	0	1	1	1	H4590_010_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	10	0	1	1	1	H4590_010_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4590	10	0	1	1	1	H4590_010_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						75				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	10	0	1	1	1	H4590_010_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	10	0	1	1	1	H4590_010_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				749	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	12	0	1	2	1	H4590_012_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	12	0	1	2	1	H4590_012_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						14				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	12	0	1	2	1	H4590_012_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	12	0	1	2	1	H4590_012_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	12	0	1	2	1	H4590_012_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				818	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	25	0	1	1	1	H4590_025_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	25	0	1	1	1	H4590_025_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	25	0	1	1	1	H4590_025_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	25	0	1	1	1	H4590_025_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	25	0	1	1	1	H4590_025_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				707	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	37	0	1	1	1	H4590_037_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	37	0	1	1	1	H4590_037_0	4	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4590	37	0	1	1	1	H4590_037_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	37	0	1	1	1	H4590_037_0	4	Generic	4	1	1	2	2	3	110		1		100	1	30		100				2	2						100	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4590	37	0	1	1	1	H4590_037_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						75				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	37	0	1	1	1	H4590_037_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	37	0	1	1	1	H4590_037_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				664	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	41	0	1	2	1	H4590_041_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	41	0	1	2	1	H4590_041_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	41	0	1	2	1	H4590_041_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	41	0	1	2	1	H4590_041_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	41	0	1	2	1	H4590_041_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1177	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	42	0	1	2	1	H4590_042_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	42	0	1	2	1	H4590_042_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	42	0	1	2	1	H4590_042_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	42	0	1	2	1	H4590_042_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	42	0	1	2	1	H4590_042_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				657	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	43	0	1	2	1	H4590_043_0	5	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	43	0	1	2	1	H4590_043_0	5	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	43	0	1	2	1	H4590_043_0	5	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	43	0	1	2	1	H4590_043_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4590	43	0	1	2	1	H4590_043_0	5	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				790	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	3	0	1	1	1	H4604_003_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	3	0	1	1	1	H4604_003_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	3	0	1	1	1	H4604_003_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	3	0	1	1	1	H4604_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	3	0	1	1	1	H4604_003_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				891	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	11	0	1	1	1	H4604_011_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	11	0	1	1	1	H4604_011_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	11	0	1	1	1	H4604_011_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	11	0	1	1	1	H4604_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	11	0	1	1	1	H4604_011_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				894	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	12	0	1	1	1	H4604_012_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	12	0	1	1	1	H4604_012_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	12	0	1	1	1	H4604_012_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	12	0	1	1	1	H4604_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	12	0	1	1	1	H4604_012_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				796	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	13	0	1	1	1	H4604_013_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	13	0	1	1	1	H4604_013_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	13	0	1	1	1	H4604_013_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	13	0	1	1	1	H4604_013_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	13	0	1	1	1	H4604_013_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				897	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	14	0	1	1	1	H4604_014_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	14	0	1	1	1	H4604_014_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	14	0	1	1	1	H4604_014_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	14	0	1	1	1	H4604_014_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	14	0	1	1	1	H4604_014_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1045	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	15	0	1	1	1	H4604_015_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	15	0	1	1	1	H4604_015_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	7		21																											21						0				7				7		0.23						0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	15	0	1	1	1	H4604_015_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	15	0	1	1	1	H4604_015_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	15	0	1	1	1	H4604_015_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				747	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	16	0	1	1	1	H4604_016_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	16	0	1	1	1	H4604_016_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	16	0	1	1	1	H4604_016_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	16	0	1	1	1	H4604_016_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	16	0	1	1	1	H4604_016_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				1483	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	17	0	1	1	1	H4604_017_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	17	0	1	1	1	H4604_017_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		100				2	2						100	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	17	0	1	1	1	H4604_017_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	17	0	1	1	1	H4604_017_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	17	0	1	1	1	H4604_017_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				700	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	18	0	1	1	1	H4604_018_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		100	2	2						100	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	18	0	1	1	1	H4604_018_0	4	Generic	4	1	1	2	2	1		110	1		100	1				30		100	2	2						100	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	18	0	1	1	1	H4604_018_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		100	2	2						100	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	18	0	1	1	1	H4604_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		100	2	2						100	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4604	18	0	1	1	1	H4604_018_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		100	2	2						100	30		31											982	29		29				802	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	2	0	1	4	1	H4605_002_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	2	0	1	4	1	H4605_002_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	2	0	1	4	1	H4605_002_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	2	0	1	4	1	H4605_002_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	2	0	1	4	1	H4605_002_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	4	0	1	4	1	H4605_004_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	4	0	1	4	1	H4605_004_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	4	0	1	4	1	H4605_004_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	4	0	1	4	1	H4605_004_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	4	0	1	4	1	H4605_004_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											853.32	33						853.32	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	7	0	1	4	1	H4605_007_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	7	0	1	4	1	H4605_007_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	7	0	1	4	1	H4605_007_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	7	0	1	4	1	H4605_007_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4605	7	0	1	4	1	H4605_007_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											698.17	27						698.17	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	1	0	1	1	1	H4623_001_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	1	0	1	1	1	H4623_001_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	1	0	1	1	1	H4623_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	1	0	1	1	1	H4623_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	1	0	1	1	1	H4623_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	2	0	1	1	1	H4623_002_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	2	0	1	1	1	H4623_002_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	2	0	1	1	1	H4623_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	2	0	1	1	1	H4623_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4623	2	0	1	1	1	H4623_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	1	0	1	1	1	H4672_001_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					7	14	0																7				7			0.23	0	0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	1	0	1	1	1	H4672_001_0	6	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					14	28	0																14				14			0.47	0	0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	1	0	1	1	1	H4672_001_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	115																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	1	0	1	1	1	H4672_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					92	184	276					100	200	275																100				100			3.33	3.07	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	1	0	1	1	1	H4672_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											649.65	33						570.9	29						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	2	0	1	1	1	H4672_002_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					2	4	6					9	18	6																9				9			0.3	0.07	0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	2	0	1	1	1	H4672_002_0	6	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					5	10	15					18	36	15																18				18			0.6	0.17	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	2	0	1	1	1	H4672_002_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	141																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	2	0	1	1	1	H4672_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	300																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	2	0	1	1	1	H4672_002_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											649.65	33						649.65	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	3	0	1	1	1	H4672_003_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					0	0	0					8	16	0																8				8			0.27	0	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	3	0	1	1	1	H4672_003_0	6	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					0	0	0					15	30	0																15				15			0.5	0	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	3	0	1	1	1	H4672_003_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	115																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	3	0	1	1	1	H4672_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								97	194	291					85	170	255					97	194	240																97				97			3.23	2.83	3.23			3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	3	0	1	1	1	H4672_003_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											649.65	33						570.9	29						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	4	0	1	1	1	H4672_004_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					0	0	0					8	16	0																8				8			0.27	0	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	4	0	1	1	1	H4672_004_0	6	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					0	0	0					15	30	0																15				15			0.5	0	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	4	0	1	1	1	H4672_004_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	115																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	4	0	1	1	1	H4672_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								97	194	291					85	170	255					97	194	240																97				97			3.23	2.83	3.23			3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	4	0	1	1	1	H4672_004_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											649.65	33						570.9	29						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	5	0	1	1	1	H4672_005_0	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					7	14	0																7				7			0.23	0	0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	5	0	1	1	1	H4672_005_0	5	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					14	28	0																14				14			0.47	0	0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	5	0	1	1	1	H4672_005_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	115																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	5	0	1	1	1	H4672_005_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								97	194	291					87	174	261					97	194	275																97				97			3.23	2.9	3.23			3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4672	5	0	1	1	1	H4672_005_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											649.65	33						649.65	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4676	1	0	1	1	1	H4676_001_0	8	Preferred Generic	4	1	1	2	1	1		111	1			1				30	60	90	2	1							30		31								10	20	30					0	0	0																							10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4676	1	0	1	1	1	H4676_001_0	8	Generic	4	1	1	2	2	1		111	1			1				30	60	90	2	1							30		31								20	40	60					5	10	15																							20				20			0.67	0.17				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4676	1	0	1	1	1	H4676_001_0	8	Preferred Brand	4	10	1	2	3	1		111	1			1				30	60	90	2	1							30		31								40	80	120					25	50	75																							40				40			1.33	0.83				1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4676	1	0	1	1	1	H4676_001_0	8	Non-Preferred Brand	4	10	1	2	4	1		111	1			1				30	60	90	2	1							30		31								100	200	300					100	200	300																							100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4676	1	0	1	1	1	H4676_001_0	8	Specialty Tier	4	10	1	1	5	1		111	1			1				30	60	90	2	1							30		31												33	33	33					33	33	33																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4709	1	0	1	1	1	H4709_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	1	0	1	1	1	H4709_001_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	1	0	1	1	1	H4709_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	1	0	1	1	1	H4709_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	1	0	1	1	1	H4709_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				764.51	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	1	0	1	1	1	H4709_001_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	1	0	1	1	1	H4709_001_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4709	3	0	1	1	1	H4709_003_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	3	0	1	1	1	H4709_003_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	5		10																			5		10																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	3	0	1	1	1	H4709_003_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	3	0	1	1	1	H4709_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	3	0	1	1	1	H4709_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				768.76	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	3	0	1	1	1	H4709_003_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	3	0	1	1	1	H4709_003_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4709	5	0	1	1	1	H4709_005_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	5	0	1	1	1	H4709_005_0	7	Generic	4	11	1	1	2	1	110		1	110		1	30		90				1	2	30		90				30		31				12.04	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	5	0	1	1	1	H4709_005_0	7	Preferred Brand	4	11	1	1	3	1	110		1	110		1	30		90				1	2	30		90				30		31				61.43	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	5	0	1	1	1	H4709_005_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				1	2	30		90				30		31				80.6	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	5	0	1	1	1	H4709_005_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				618.56	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	5	0	1	1	1	H4709_005_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4709	5	0	1	1	1	H4709_005_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4711	1	0	1	1	1	H4711_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	1	0	1	1	1	H4711_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	1	0	1	1	1	H4711_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	1	0	1	1	1	H4711_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	1	0	1	1	1	H4711_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	1	0	1	1	1	H4711_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	1	0	1	1	1	H4711_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											726.9	33						686.26	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	2	0	1	1	1	H4711_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	2	0	1	1	1	H4711_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	2	0	1	1	1	H4711_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	2	0	1	1	1	H4711_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	2	0	1	1	1	H4711_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	2	0	1	1	1	H4711_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	2	0	1	1	1	H4711_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											726.89	33						686.27	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	5	0	1	1	1	H4711_005_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	5	0	1	1	1	H4711_005_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	5	0	1	1	1	H4711_005_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	5	0	1	1	1	H4711_005_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	5	0	1	1	1	H4711_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	5	0	1	1	1	H4711_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	5	0	1	1	1	H4711_005_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											726.9	33						686.26	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	6	0	1	1	1	H4711_006_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	6	0	1	1	1	H4711_006_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	6	0	1	1	1	H4711_006_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	6	0	1	1	1	H4711_006_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	6	0	1	1	1	H4711_006_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	6	0	1	1	1	H4711_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	6	0	1	1	1	H4711_006_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											772.53	33						727.98	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	7	0	1	1	1	H4711_007_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	7	0	1	1	1	H4711_007_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	7	0	1	1	1	H4711_007_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	7	0	1	1	1	H4711_007_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4711	7	0	1	1	1	H4711_007_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	7	0	1	1	1	H4711_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4711	7	0	1	1	1	H4711_007_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											772.48	33						727.95	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4754	4	0	1	4	1	H4754_004_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	4	0	1	4	1	H4754_004_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	4	0	1	4	1	H4754_004_0	5	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	4	0	1	4	1	H4754_004_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											98.67	33	33	33				98.26	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	4	0	1	4	1	H4754_004_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	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	4	0	1	4	1	H4754_004_0	5	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	4	0	1	4	1	H4754_004_0	5	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4754	7	0	1	4	1	H4754_007_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	7	0	1	4	1	H4754_007_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	7	0	1	4	1	H4754_007_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	7	0	1	4	1	H4754_007_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											74.88	33	33	33				72.98	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	7	0	1	4	1	H4754_007_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	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	7	0	1	4	1	H4754_007_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	7	0	1	4	1	H4754_007_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4754	9	0	1	4	1	H4754_009_0	6	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	9	0	1	4	1	H4754_009_0	6	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	9	0	1	4	1	H4754_009_0	6	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	9	0	1	4	1	H4754_009_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											87.7	33	33	33				82.78	31	31	31										33	33	33				31	31	31			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	9	0	1	4	1	H4754_009_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	9	0	1	4	1	H4754_009_0	6	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	9	0	1	4	1	H4754_009_0	6	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4754	11	0	1	4	1	H4754_011_0	5	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					3	6	9											8	16	24				0	0	0				8				8			0.27	0.1		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	11	0	1	4	1	H4754_011_0	5	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								17	34	51					12	24	36											17	34	51				12	24	24				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	11	0	1	4	1	H4754_011_0	5	Preferred Brand	4	10	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	74				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	11	0	1	4	1	H4754_011_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											98.8	32	32	32				94.9	31	31	31										32	32	32				31	31	31			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	11	0	1	4	1	H4754_011_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	11	0	1	4	1	H4754_011_0	5	Select Care Drugs	4	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4754	11	0	1	4	1	H4754_011_0	5	Select Care Drugs	4	1	1	2	6	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								0	0	0					0	0	0											0	0	0				0	0	0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4778	1	0	1	1	1	H4778_001_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	1	0	1	1	1	H4778_001_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	1	0	1	1	1	H4778_001_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	1	0	1	1	1	H4778_001_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	1	0	1	1	1	H4778_001_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	2	0	1	1	1	H4778_002_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	2	0	1	1	1	H4778_002_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	2	0	1	1	1	H4778_002_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	2	0	1	1	1	H4778_002_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	2	0	1	1	1	H4778_002_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	3	0	1	1	1	H4778_003_0	9	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	3	0	1	1	1	H4778_003_0	9	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	3	0	1	1	1	H4778_003_0	9	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	3	0	1	1	1	H4778_003_0	9	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4778	3	0	1	1	1	H4778_003_0	9	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H4835	1	0	1	1	1	H4835_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	1	0	1	1	1	H4835_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	1	0	1	1	1	H4835_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	1	0	1	1	1	H4835_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	1	0	1	1	1	H4835_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	1	0	1	1	1	H4835_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	1	0	1	1	1	H4835_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											767.03	33						719.95	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	2	0	1	1	1	H4835_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	2	0	1	1	1	H4835_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	2	0	1	1	1	H4835_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	2	0	1	1	1	H4835_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	2	0	1	1	1	H4835_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	2	0	1	1	1	H4835_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	2	0	1	1	1	H4835_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											767.04	33						719.97	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	3	0	1	1	1	H4835_003_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	3	0	1	1	1	H4835_003_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	3	0	1	1	1	H4835_003_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	3	0	1	1	1	H4835_003_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	3	0	1	1	1	H4835_003_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	3	0	1	1	1	H4835_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	3	0	1	1	1	H4835_003_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											767.02	33						719.96	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	4	0	1	1	1	H4835_004_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	4	0	1	1	1	H4835_004_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	4	0	1	1	1	H4835_004_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	4	0	1	1	1	H4835_004_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	4	0	1	1	1	H4835_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	4	0	1	1	1	H4835_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	4	0	1	1	1	H4835_004_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											767.04	33						719.96	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	5	0	1	1	1	H4835_005_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	5	0	1	1	1	H4835_005_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	5	0	1	1	1	H4835_005_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	5	0	1	1	1	H4835_005_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	5	0	1	1	1	H4835_005_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	5	0	1	1	1	H4835_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	5	0	1	1	1	H4835_005_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											660.46	28						619.55	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	6	0	1	1	1	H4835_006_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	6	0	1	1	1	H4835_006_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	6	0	1	1	1	H4835_006_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	6	0	1	1	1	H4835_006_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4835	6	0	1	1	1	H4835_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	6	0	1	1	1	H4835_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4835	6	0	1	1	1	H4835_006_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											638.85	27						599.25	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4847	1	0	1	1	1	H4847_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	1	0	1	1	1	H4847_001_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H4847	1	0	1	1	1	H4847_001_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	1	0	1	1	1	H4847_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	1	0	1	1	1	H4847_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		270																									90		270				90		180				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	1	0	1	1	1	H4847_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	2	0	1	1	1	H4847_002_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	2	0	1	1	1	H4847_002_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H4847	2	0	1	1	1	H4847_002_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	2	0	1	1	1	H4847_002_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	2	0	1	1	1	H4847_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	90		270																									90		270				90		180				90				90		3				3	3	2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	2	0	1	1	1	H4847_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	3	0	1	1	1	H4847_003_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	3	0	1	1	1	H4847_003_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	3	0	1	1	1	H4847_003_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	3	0	1	1	1	H4847_003_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.49	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	3	0	1	1	1	H4847_003_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	4	0	1	1	1	H4847_004_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	4	0	1	1	1	H4847_004_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	4	0	1	1	1	H4847_004_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	4	0	1	1	1	H4847_004_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.49	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	4	0	1	1	1	H4847_004_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	5	0	1	1	1	H4847_005_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	5	0	1	1	1	H4847_005_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	5	0	1	1	1	H4847_005_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	5	0	1	1	1	H4847_005_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				84.02	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4847	5	0	1	1	1	H4847_005_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4853	1	0	1	1	1	H4853_001_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	1	0	1	1	1	H4853_001_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	1	0	1	1	1	H4853_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	1	0	1	1	1	H4853_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	1	0	1	1	1	H4853_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				678.55	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	1	0	1	1	1	H4853_001_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	1	0	1	1	1	H4853_001_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4853	2	0	1	1	1	H4853_002_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	2	0	1	1	1	H4853_002_0	7	Generic	4	11	1	1	2	1	110		1	110		1	30		90				1	2	30		90				30		31				9.95	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	2	0	1	1	1	H4853_002_0	7	Preferred Brand	4	11	1	1	3	1	110		1	110		1	30		90				1	2	30		90				30		31				59.34	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	2	0	1	1	1	H4853_002_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				1	2	30		90				30		31				75.97	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	2	0	1	1	1	H4853_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				604.53	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	2	0	1	1	1	H4853_002_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	2	0	1	1	1	H4853_002_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4853	3	0	1	2	1	H4853_003_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	2		4																			2		4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	3	0	1	2	1	H4853_003_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	3	0	1	2	1	H4853_003_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	3	0	1	2	1	H4853_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	3	0	1	2	1	H4853_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				754.47	32																				32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	3	0	1	2	1	H4853_003_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	3	0	1	2	1	H4853_003_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4853	4	0	1	2	1	H4853_004_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	4	0	1	2	1	H4853_004_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	4	0	1	2	1	H4853_004_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	4	0	1	2	1	H4853_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	4	0	1	2	1	H4853_004_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				745.81	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	4	0	1	2	1	H4853_004_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4853	4	0	1	2	1	H4853_004_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4868	1	0	1	1	1	H4868_001_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	1	0	1	1	1	H4868_001_0	9	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H4868	1	0	1	1	1	H4868_001_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	1	0	1	1	1	H4868_001_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	1	0	1	1	1	H4868_001_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				80.71	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	1	0	1	1	1	H4868_001_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	2	0	1	1	1	H4868_002_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	2	0	1	1	1	H4868_002_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	2	0	1	1	1	H4868_002_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	2	0	1	1	1	H4868_002_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.9	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	2	0	1	1	1	H4868_002_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	4	0	1	1	1	H4868_004_0	11	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	4	0	1	1	1	H4868_004_0	11	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	11		33																									11		33				11		0				11				11		0.37				0.37	0.37	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	4	0	1	1	1	H4868_004_0	11	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	4	0	1	1	1	H4868_004_0	11	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.56	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	4	0	1	1	1	H4868_004_0	11	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	7	0	1	1	1	H4868_007_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	7	0	1	1	1	H4868_007_0	9	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H4868	7	0	1	1	1	H4868_007_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	7	0	1	1	1	H4868_007_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	7	0	1	1	1	H4868_007_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				75.82	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	7	0	1	1	1	H4868_007_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	8	0	1	1	1	H4868_008_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	8	0	1	1	1	H4868_008_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	8	0	1	1	1	H4868_008_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	8	0	1	1	1	H4868_008_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				76.08	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	8	0	1	1	1	H4868_008_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	10	0	1	1	1	H4868_010_0	10	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	10	0	1	1	1	H4868_010_0	10	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H4868	10	0	1	1	1	H4868_010_0	10	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	10	0	1	1	1	H4868_010_0	10	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	10	0	1	1	1	H4868_010_0	10	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				78.79	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	10	0	1	1	1	H4868_010_0	10	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	14	0	1	1	1	H4868_014_0	9	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	14	0	1	1	1	H4868_014_0	9	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	14	0	1	1	1	H4868_014_0	9	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	14	0	1	1	1	H4868_014_0	9	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.63	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	14	0	1	1	1	H4868_014_0	9	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	15	0	1	1	1	H4868_015_0	9	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	15	0	1	1	1	H4868_015_0	9	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	15	0	1	1	1	H4868_015_0	9	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	15	0	1	1	1	H4868_015_0	9	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.63	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	15	0	1	1	1	H4868_015_0	9	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	16	0	1	1	1	H4868_016_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	16	0	1	1	1	H4868_016_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	16	0	1	1	1	H4868_016_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	16	0	1	1	1	H4868_016_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				88.65	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	16	0	1	1	1	H4868_016_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	17	0	1	1	1	H4868_017_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	17	0	1	1	1	H4868_017_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	17	0	1	1	1	H4868_017_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	17	0	1	1	1	H4868_017_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				88.65	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	17	0	1	1	1	H4868_017_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	18	0	1	1	1	H4868_018_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	18	0	1	1	1	H4868_018_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	18	0	1	1	1	H4868_018_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	18	0	1	1	1	H4868_018_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				83.89	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	18	0	1	1	1	H4868_018_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	19	0	1	1	1	H4868_019_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	19	0	1	1	1	H4868_019_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	19	0	1	1	1	H4868_019_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	19	0	1	1	1	H4868_019_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				83.89	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	19	0	1	1	1	H4868_019_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	20	0	1	1	1	H4868_020_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	20	0	1	1	1	H4868_020_0	9	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4868	20	0	1	1	1	H4868_020_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	20	0	1	1	1	H4868_020_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	20	0	1	1	1	H4868_020_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				73.16	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	20	0	1	1	1	H4868_020_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	21	0	1	1	1	H4868_021_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	21	0	1	1	1	H4868_021_0	9	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4868	21	0	1	1	1	H4868_021_0	9	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	21	0	1	1	1	H4868_021_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	21	0	1	1	1	H4868_021_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				73.16	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	21	0	1	1	1	H4868_021_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	22	0	1	1	1	H4868_022_0	9	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	22	0	1	1	1	H4868_022_0	9	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4868	22	0	1	1	1	H4868_022_0	9	Generic	4	11	3	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	22	0	1	1	1	H4868_022_0	9	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	22	0	1	1	1	H4868_022_0	9	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.1	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4868	22	0	1	1	1	H4868_022_0	9	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	1	1	4	1	H4875_016_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	1	1	4	1	H4875_016_1	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	1	1	4	1	H4875_016_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	1	1	4	1	H4875_016_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											30.04	50	50	50				31.63	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	1	1	4	1	H4875_016_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	2	1	4	1	H4875_016_2	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	2	1	4	1	H4875_016_2	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	2	1	4	1	H4875_016_2	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	2	1	4	1	H4875_016_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											30.04	50	50	50				31.63	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	2	1	4	1	H4875_016_2	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	3	1	4	1	H4875_016_3	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	3	1	4	1	H4875_016_3	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	3	1	4	1	H4875_016_3	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	3	1	4	1	H4875_016_3	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											30.04	50	50	50				31.63	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	3	1	4	1	H4875_016_3	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	4	1	4	1	H4875_016_4	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	4	1	4	1	H4875_016_4	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	4	1	4	1	H4875_016_4	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	4	1	4	1	H4875_016_4	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											30.04	50	50	50				31.63	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	4	1	4	1	H4875_016_4	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	5	1	4	1	H4875_016_5	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	4	0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	5	1	4	1	H4875_016_5	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	0																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	5	1	4	1	H4875_016_5	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	5	1	4	1	H4875_016_5	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											30.04	50	50	50				31.63	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	16	5	1	4	1	H4875_016_5	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	1	1	4	1	H4875_017_1	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	1	1	4	1	H4875_017_1	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	0																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	1	1	4	1	H4875_017_1	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								42	84	126					37	74	111					37	74	92.5																42				42			1.4	1.23	1.23			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	1	1	4	1	H4875_017_1	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											48.12	50	50	50				34.98	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	1	1	4	1	H4875_017_1	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	2	1	4	1	H4875_017_2	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	2	1	4	1	H4875_017_2	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	0																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	2	1	4	1	H4875_017_2	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								42	84	126					37	74	111					37	74	92.5																42				42			1.4	1.23	1.23			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	2	1	4	1	H4875_017_2	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											48.12	50	50	50				34.98	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	2	1	4	1	H4875_017_2	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	3	1	4	1	H4875_017_3	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	3	1	4	1	H4875_017_3	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	0																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	3	1	4	1	H4875_017_3	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								42	84	126					37	74	111					37	74	92.5																42				42			1.4	1.23	1.23			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	3	1	4	1	H4875_017_3	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											48.12	50	50	50				34.98	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	3	1	4	1	H4875_017_3	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	4	1	4	1	H4875_017_4	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	4	1	4	1	H4875_017_4	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	0																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	4	1	4	1	H4875_017_4	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								42	84	126					37	74	111					37	74	92.5																42				42			1.4	1.23	1.23			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	4	1	4	1	H4875_017_4	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											48.12	50	50	50				34.98	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	4	1	4	1	H4875_017_4	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	5	1	4	1	H4875_017_5	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	2	0																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	5	1	4	1	H4875_017_5	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	0																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	5	1	4	1	H4875_017_5	8	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								42	84	126					37	74	111					37	74	92.5																42				42			1.4	1.23	1.23			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	5	1	4	1	H4875_017_5	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											48.12	50	50	50				34.98	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	17	5	1	4	1	H4875_017_5	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	33						1	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	1	1	4	1	H4875_018_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					4	8	12					4	8	0																9				9			0.3	0.13	0.13			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	1	1	4	1	H4875_018_1	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					13	26	39					13	26	0																18				18			0.6	0.43	0.43			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	1	1	4	1	H4875_018_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	1	1	4	1	H4875_018_1	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											58.49	50	50	50				47.78	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	1	1	4	1	H4875_018_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	2	1	4	1	H4875_018_2	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					4	8	12					4	8	0																9				9			0.3	0.13	0.13			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	2	1	4	1	H4875_018_2	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					13	26	39					13	26	0																18				18			0.6	0.43	0.43			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	2	1	4	1	H4875_018_2	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	2	1	4	1	H4875_018_2	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											58.49	50	50	50				47.78	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	2	1	4	1	H4875_018_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	3	1	4	1	H4875_018_3	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					4	8	12					4	8	0																9				9			0.3	0.13	0.13			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	3	1	4	1	H4875_018_3	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					13	26	39					13	26	0																18				18			0.6	0.43	0.43			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	3	1	4	1	H4875_018_3	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	3	1	4	1	H4875_018_3	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											58.49	50	50	50				47.78	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	3	1	4	1	H4875_018_3	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	4	1	4	1	H4875_018_4	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					4	8	12					4	8	0																9				9			0.3	0.13	0.13			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	4	1	4	1	H4875_018_4	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					13	26	39					13	26	0																18				18			0.6	0.43	0.43			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	4	1	4	1	H4875_018_4	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	4	1	4	1	H4875_018_4	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											58.49	50	50	50				47.78	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	4	1	4	1	H4875_018_4	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	5	1	4	1	H4875_018_5	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					4	8	12					4	8	0																9				9			0.3	0.13	0.13			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	5	1	4	1	H4875_018_5	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					13	26	39					13	26	0																18				18			0.6	0.43	0.43			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	5	1	4	1	H4875_018_5	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	5	1	4	1	H4875_018_5	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											58.49	50	50	50				47.78	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	18	5	1	4	1	H4875_018_5	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	19	0	1	4	1	H4875_019_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					2	4	6					2	4	0																6				6			0.2	0.07	0.07			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	19	0	1	4	1	H4875_019_0	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								13	26	39					8	16	24					8	16	0																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	19	0	1	4	1	H4875_019_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								43	86	129					38	76	114					38	76	95																43				43			1.43	1.27	1.27			1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	19	0	1	4	1	H4875_019_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											64.43	45	45	45				49.36	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4875	19	0	1	4	1	H4875_019_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											100	31						100	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	1	0	1	4	1	H4882_001_0	5	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	6		18																									6		18				6		12				6				6		0.2				0.2	0.2	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	1	0	1	4	1	H4882_001_0	5	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		24				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	1	0	1	4	1	H4882_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		131				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	1	0	1	4	1	H4882_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				93.86	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	1	0	1	4	1	H4882_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					27																										27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	2	0	1	4	1	H4882_002_0	5	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		16				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	2	0	1	4	1	H4882_002_0	5	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	14		42																									14		42				14		28				14				14		0.47				0.47	0.47	0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	2	0	1	4	1	H4882_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		131				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	2	0	1	4	1	H4882_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				96.7	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	2	0	1	4	1	H4882_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					27																										27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	3	0	1	4	1	H4882_003_0	6	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	4		12																									4		12				4		8				4				4		0.13				0.13	0.13	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	3	0	1	4	1	H4882_003_0	6	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	3	0	1	4	1	H4882_003_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		131				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	3	0	1	4	1	H4882_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				87.95	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	3	0	1	4	1	H4882_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					27																										27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	4	0	1	4	1	H4882_004_0	5	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		4				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	4	0	1	4	1	H4882_004_0	5	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		18				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	4	0	1	4	1	H4882_004_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		131				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	4	0	1	4	1	H4882_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		290				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	4	0	1	4	1	H4882_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				281.34	29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	5	0	1	4	1	H4882_005_0	5	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		4				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	5	0	1	4	1	H4882_005_0	5	Preferred Generic	4	1	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		4				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4882	5	0	1	4	1	H4882_005_0	5	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		18				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	5	0	1	4	1	H4882_005_0	5	Generic	4	1	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		18				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4882	5	0	1	4	1	H4882_005_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		131				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	5	0	1	4	1	H4882_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		290				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	5	0	1	4	1	H4882_005_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				275.95	29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	6	0	1	4	1	H4882_006_0	5	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		10				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	6	0	1	4	1	H4882_006_0	5	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		20				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	6	0	1	4	1	H4882_006_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		131				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	6	0	1	4	1	H4882_006_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				91.16	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4882	6	0	1	4	1	H4882_006_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					27																										27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4909	14	0	1	4	1	H4909_014_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	14	0	1	4	1	H4909_014_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	14	0	1	4	1	H4909_014_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	14	0	1	4	1	H4909_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	14	0	1	4	1	H4909_014_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	14	0	1	4	1	H4909_014_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	14	0	1	4	1	H4909_014_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4909	15	0	1	4	1	H4909_015_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	15	0	1	4	1	H4909_015_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								18	36	54					13	26	39					13	26	26																18				18			0.6	0.43	0.43			0.53	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	15	0	1	4	1	H4909_015_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	15	0	1	4	1	H4909_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	15	0	1	4	1	H4909_015_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	15	0	1	4	1	H4909_015_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	15	0	1	4	1	H4909_015_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4909	16	0	1	4	1	H4909_016_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					0	0	0																9				9			0.3	0.13	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	16	0	1	4	1	H4909_016_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								18	36	54					13	26	39					13	26	26																18				18			0.6	0.43	0.43			0.53	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	16	0	1	4	1	H4909_016_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	16	0	1	4	1	H4909_016_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	16	0	1	4	1	H4909_016_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	16	0	1	4	1	H4909_016_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4909	16	0	1	4	1	H4909_016_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4922	11	0	1	1	1	H4922_011_0	7	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4922	11	0	1	1	1	H4922_011_0	7	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	3	6	7.5																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4922	11	0	1	1	1	H4922_011_0	7	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	30																					18																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4922	11	0	1	1	1	H4922_011_0	7	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	129.25																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4922	11	0	1	1	1	H4922_011_0	7	Non-Preferred Drug	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	275																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4922	11	0	1	1	1	H4922_011_0	7	Specialty Tier	4	11	1	1	5	1	111		1	100		1	30	60	90				1	2			90				30		31				100	27	27	27																				27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H4937	1	0	1	4	1	H4937_001_0	14	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4937	1	0	1	4	1	H4937_001_0	14	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	1	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4937	1	0	1	4	1	H4937_001_0	14	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								20	40	60					15	30	22.5							22.5																20				20			0.67	0.5				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4937	1	0	1	4	1	H4937_001_0	14	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4937	1	0	1	4	1	H4937_001_0	14	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	300					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4937	1	0	1	4	1	H4937_001_0	14	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											820.79	25						820.79	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4937	1	0	1	4	1	H4937_001_0	14	Select Care Drugs	4	10	1	2	6	1		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H4937	1	0	1	4	1	H4937_001_0	14	Select Care Drugs	4	10	1	2	6	3		111	1	100		1				30	60	90	1	2			90				30		31								10	10	10					5	5	5							5																10				10			0.33	0.17				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H4961	1	0	1	4	1	H4961_001_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	1	0	1	4	1	H4961_001_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	1	0	1	4	1	H4961_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	1	0	1	4	1	H4961_001_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	1	0	1	4	1	H4961_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	1	0	1	4	1	H4961_001_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	1	0	1	4	1	H4961_001_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H4961	2	0	1	4	1	H4961_002_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	2	0	1	4	1	H4961_002_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	2	0	1	4	1	H4961_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	2	0	1	4	1	H4961_002_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	2	0	1	4	1	H4961_002_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	2	0	1	4	1	H4961_002_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	2	0	1	4	1	H4961_002_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H4961	3	0	1	4	1	H4961_003_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	3	0	1	4	1	H4961_003_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	3	0	1	4	1	H4961_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	3	0	1	4	1	H4961_003_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	3	0	1	4	1	H4961_003_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	3	0	1	4	1	H4961_003_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	3	0	1	4	1	H4961_003_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H4961	4	0	1	4	1	H4961_004_0	4	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7	7	7					0	0	0					0	0	0																	7			0			0.23	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	4	0	1	4	1	H4961_004_0	4	Generic	4	1	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12	17	22					5	10	15					5	10	15																	12			5			0.4	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	4	0	1	4	1	H4961_004_0	4	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47	87	127					40	80	120					40	80	120																	47			40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	4	0	1	4	1	H4961_004_0	4	Non-Preferred Brand	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100	200	300					100	200	300					100	200	300																	100			100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	4	0	1	4	1	H4961_004_0	4	Specialty Tier	4	11	1	1	5	1		10	10	10		1				30					30							10	31											1462	33						1462	33						33																		33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	4	0	1	4	1	H4961_004_0	4	Select Care Drugs	4	1	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H4961	4	0	1	4	1	H4961_004_0	4	Select Care Drugs	4	1	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5	10	0					5	10	0					5	10	0																	5			5			0.17	0.17	0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H4982	1	0	1	1	1	H4982_001_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	1	0	1	1	1	H4982_001_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	1	0	1	1	1	H4982_001_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	1	0	1	1	1	H4982_001_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	1	0	1	1	1	H4982_001_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					42	84	126											47	94	141				42	84	126					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	1	0	1	1	1	H4982_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					99	198	297											100	200	300				99	198	297					100			100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	1	0	1	1	1	H4982_001_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											859.73	33						854.45	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	2	0	1	1	1	H4982_002_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	2	0	1	1	1	H4982_002_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	2	0	1	1	1	H4982_002_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	2	0	1	1	1	H4982_002_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	2	0	1	1	1	H4982_002_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					42	84	126											47	94	141				42	84	126					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	2	0	1	1	1	H4982_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					99	198	297											100	200	300				99	198	297					100			100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	2	0	1	1	1	H4982_002_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											859.8	33						854.5	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	3	0	1	1	1	H4982_003_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	3	0	1	1	1	H4982_003_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	3	0	1	1	1	H4982_003_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	3	0	1	1	1	H4982_003_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	3	0	1	1	1	H4982_003_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					42	84	126											47	94	141				42	84	126					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	3	0	1	1	1	H4982_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					99	198	297											100	200	300				99	198	297					100			100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	3	0	1	1	1	H4982_003_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											859.66	33						854.39	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	4	0	1	1	1	H4982_004_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	4	0	1	1	1	H4982_004_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	4	0	1	1	1	H4982_004_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	4	0	1	1	1	H4982_004_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	4	0	1	1	1	H4982_004_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					42	84	126											47	94	141				42	84	126					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	4	0	1	1	1	H4982_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					99	198	297											100	200	300				99	198	297					100			100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	4	0	1	1	1	H4982_004_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											859.82	33						854.51	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	5	0	1	1	1	H4982_005_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	5	0	1	1	1	H4982_005_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	5	0	1	1	1	H4982_005_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	5	0	1	1	1	H4982_005_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	5	0	1	1	1	H4982_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	5	0	1	1	1	H4982_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	5	0	1	1	1	H4982_005_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											860.04	33						854.68	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	6	0	1	1	1	H4982_006_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	6	0	1	1	1	H4982_006_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	6	0	1	1	1	H4982_006_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	6	0	1	1	1	H4982_006_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	6	0	1	1	1	H4982_006_0	2	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	6	0	1	1	1	H4982_006_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	6	0	1	1	1	H4982_006_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											860.2	33						854.8	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	7	0	1	1	1	H4982_007_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	7	0	1	1	1	H4982_007_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	7	0	1	1	1	H4982_007_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	7	0	1	1	1	H4982_007_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H4982	7	0	1	1	1	H4982_007_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	7	0	1	1	1	H4982_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H4982	7	0	1	1	1	H4982_007_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											860.04	33						854.68	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5009	2	0	1	4	1	H5009_002_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	2	0	1	4	1	H5009_002_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	2	0	1	4	1	H5009_002_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	2	0	1	4	1	H5009_002_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	2	0	1	4	1	H5009_002_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											698.17	27						698.17	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	8	0	1	4	1	H5009_008_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	8	0	1	4	1	H5009_008_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	8	0	1	4	1	H5009_008_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	8	0	1	4	1	H5009_008_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	8	0	1	4	1	H5009_008_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											672.32	26						672.32	26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	9	0	1	4	1	H5009_009_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	9	0	1	4	1	H5009_009_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	9	0	1	4	1	H5009_009_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	9	0	1	4	1	H5009_009_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5009	9	0	1	4	1	H5009_009_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											672.32	26						672.32	26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	2	0	1	4	1	H5010_002_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	2	0	1	4	1	H5010_002_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	2	0	1	4	1	H5010_002_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	2	0	1	4	1	H5010_002_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	2	0	1	4	1	H5010_002_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											698.17	27						698.17	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	4	0	1	4	1	H5010_004_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	4	0	1	4	1	H5010_004_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	4	0	1	4	1	H5010_004_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	4	0	1	4	1	H5010_004_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	4	0	1	4	1	H5010_004_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											853.32	33						853.32	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	7	0	1	4	1	H5010_007_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	7	0	1	4	1	H5010_007_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								20	40	40					13	26	26					13	26	26																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	7	0	1	4	1	H5010_007_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	7	0	1	4	1	H5010_007_0	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5010	7	0	1	4	1	H5010_007_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											672.32	26						672.32	26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	9	0	1	4	1	H5042_009_0	16	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	3		9																									3		9				3		6				3				3		0.1				0.1	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	9	0	1	4	1	H5042_009_0	16	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	17		51																									17		51				17		34				17				17		0.57				0.57	0.57	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	9	0	1	4	1	H5042_009_0	16	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	9	0	1	4	1	H5042_009_0	16	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		250				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	9	0	1	4	1	H5042_009_0	16	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				1399.46	26																										26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	11	0	1	4	1	H5042_011_0	19	Preferred Generic	4	1	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		4				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	11	0	1	4	1	H5042_011_0	19	Generic	4	1	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	14		42																									14		42				14		28				14				14		0.47				0.47	0.47	0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	11	0	1	4	1	H5042_011_0	19	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	44		132																									44		132				44		88				44				44		1.47				1.47	1.47	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	11	0	1	4	1	H5042_011_0	19	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	95		285																									95		285				95		237.5				95				95		3.17				3.17	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5042	11	0	1	4	1	H5042_011_0	19	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31				1399.46	33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5050	4	0	1	1	1	H5050_004_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	4	0	1	1	1	H5050_004_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	4	0	1	1	1	H5050_004_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	4	0	1	1	1	H5050_004_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	4	0	1	1	1	H5050_004_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	4	0	1	1	1	H5050_004_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.16			3.16			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	4	0	1	1	1	H5050_004_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1624	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	4	0	1	1	1	H5050_004_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	4	0	1	1	1	H5050_004_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	9	0	1	1	1	H5050_009_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	9	0	1	1	1	H5050_009_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	9	0	1	1	1	H5050_009_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	9	0	1	1	1	H5050_009_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	9	0	1	1	1	H5050_009_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	9	0	1	1	1	H5050_009_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.16			3.16			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	9	0	1	1	1	H5050_009_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1596	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	9	0	1	1	1	H5050_009_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	9	0	1	1	1	H5050_009_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	13	0	1	1	1	H5050_013_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	13	0	1	1	1	H5050_013_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	13	0	1	1	1	H5050_013_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	13	0	1	1	1	H5050_013_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	13	0	1	1	1	H5050_013_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	13	0	1	1	1	H5050_013_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.16			3.16			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	13	0	1	1	1	H5050_013_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1107	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	13	0	1	1	1	H5050_013_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	13	0	1	1	1	H5050_013_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	17	0	1	1	1	H5050_017_0	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	17	0	1	1	1	H5050_017_0	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	17	0	1	1	1	H5050_017_0	8	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	17	0	1	1	1	H5050_017_0	8	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	17	0	1	1	1	H5050_017_0	8	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.56			1.56			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	17	0	1	1	1	H5050_017_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	97	194	291																			97	194	194																97				97		3.23			3.23			3.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	17	0	1	1	1	H5050_017_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				949	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	17	0	1	1	1	H5050_017_0	8	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	17	0	1	1	1	H5050_017_0	8	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	19	0	1	1	1	H5050_019_0	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	19	0	1	1	1	H5050_019_0	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	19	0	1	1	1	H5050_019_0	8	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	19	0	1	1	1	H5050_019_0	8	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	19	0	1	1	1	H5050_019_0	8	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	40	80	120																			40	80	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	19	0	1	1	1	H5050_019_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	90	180	270																			90	180	180																90				90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	19	0	1	1	1	H5050_019_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1955	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	19	0	1	1	1	H5050_019_0	8	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	19	0	1	1	1	H5050_019_0	8	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	21	0	1	1	1	H5050_021_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	21	0	1	1	1	H5050_021_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	0	0																3				3		0.1			0.1			0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	21	0	1	1	1	H5050_021_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	21	0	1	1	1	H5050_021_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	7	14	21																			7	14	14																7				7		0.23			0.23			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	21	0	1	1	1	H5050_021_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	21	0	1	1	1	H5050_021_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.16			3.16			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	21	0	1	1	1	H5050_021_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				893	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	21	0	1	1	1	H5050_021_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	21	0	1	1	1	H5050_021_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	22	0	1	1	1	H5050_022_0	9	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			5	0	0																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	22	0	1	1	1	H5050_022_0	9	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			5	0	0																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	22	0	1	1	1	H5050_022_0	9	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	22	0	1	1	1	H5050_022_0	9	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	45																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5050	22	0	1	1	1	H5050_022_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	22	0	1	1	1	H5050_022_0	9	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	190																95				95		3.16			3.16			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	22	0	1	1	1	H5050_022_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1107	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	22	0	1	1	1	H5050_022_0	9	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H5050	22	0	1	1	1	H5050_022_0	9	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H5087	1	0	1	1	1	H5087_001_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	1	0	1	1	1	H5087_001_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	1	0	1	1	1	H5087_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	1	0	1	1	1	H5087_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				92.57	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	1	0	1	1	1	H5087_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	2	0	1	1	1	H5087_002_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	2	0	1	1	1	H5087_002_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	2	0	1	1	1	H5087_002_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	2	0	1	1	1	H5087_002_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.08	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	2	0	1	1	1	H5087_002_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	5	0	1	1	1	H5087_005_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	5	0	1	1	1	H5087_005_0	4	Preferred Generic	4	11	3	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5087	5	0	1	1	1	H5087_005_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	5	0	1	1	1	H5087_005_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	25		75																									25		75				25		50				25				25		0.83				0.83	0.83	0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	5	0	1	1	1	H5087_005_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	5	0	1	1	1	H5087_005_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	16	0	1	1	1	H5087_016_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	16	0	1	1	1	H5087_016_0	4	Preferred Generic	4	11	3	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5087	16	0	1	1	1	H5087_016_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	16	0	1	1	1	H5087_016_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	16	0	1	1	1	H5087_016_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	16	0	1	1	1	H5087_016_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	17	0	1	1	1	H5087_017_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	17	0	1	1	1	H5087_017_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	17	0	1	1	1	H5087_017_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	17	0	1	1	1	H5087_017_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.58	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	17	0	1	1	1	H5087_017_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	24	0	1	1	1	H5087_024_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	24	0	1	1	1	H5087_024_0	4	Preferred Generic	4	11	3	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5087	24	0	1	1	1	H5087_024_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	24	0	1	1	1	H5087_024_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	24	0	1	1	1	H5087_024_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	24	0	1	1	1	H5087_024_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	25	0	1	1	1	H5087_025_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	25	0	1	1	1	H5087_025_0	4	Preferred Generic	4	11	3	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5087	25	0	1	1	1	H5087_025_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	25	0	1	1	1	H5087_025_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	25	0	1	1	1	H5087_025_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5087	25	0	1	1	1	H5087_025_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	13	0	1	4	1	H5106_013_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								5		15					0		0													15						0				5				5			0.16	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	13	0	1	4	1	H5106_013_0	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								19		57					13		39													57						27				19				19			0.61	0.42				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	13	0	1	4	1	H5106_013_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					45		135													141						115				47				47			1.52	1.45				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	13	0	1	4	1	H5106_013_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					95		285													300						275				100				100			3.23	3.06				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	13	0	1	4	1	H5106_013_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1144.75	33						1144.75	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	1	1	4	1	H5106_029_1	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	1	1	4	1	H5106_029_1	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								20		60					9		27													60						27				20				20			0.65	0.29				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	1	1	4	1	H5106_029_1	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	1	1	4	1	H5106_029_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						280				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	1	1	4	1	H5106_029_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1101.22	33						1101.22	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	2	1	4	1	H5106_029_2	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								7		21					0		0													21						0				7				7			0.23	0				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	2	1	4	1	H5106_029_2	4	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								20		60					9		27													60						27				20				20			0.65	0.29				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	2	1	4	1	H5106_029_2	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								47		141					47		141													141						120				47				47			1.52	1.52				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	2	1	4	1	H5106_029_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				31		90	1	2						90	31		31								100		300					100		300													300						280				100				100			3.23	3.23				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5106	29	2	1	4	1	H5106_029_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1101.22	33						1101.22	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5117	3	0	1	1	1	H5117_003_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	3	0	1	1	1	H5117_003_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	30																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	3	0	1	1	1	H5117_003_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	3	0	1	1	1	H5117_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	3	0	1	1	1	H5117_003_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	3	0	1	1	1	H5117_003_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	4	0	1	1	1	H5117_004_0	2	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	4	0	1	1	1	H5117_004_0	2	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	21																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	4	0	1	1	1	H5117_004_0	2	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	4	0	1	1	1	H5117_004_0	2	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	4	0	1	1	1	H5117_004_0	2	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	4	0	1	1	1	H5117_004_0	2	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	5	0	1	1	1	H5117_005_0	3	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	5	0	1	1	1	H5117_005_0	3	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	21																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	5	0	1	1	1	H5117_005_0	3	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	5	0	1	1	1	H5117_005_0	3	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	5	0	1	1	1	H5117_005_0	3	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5117	5	0	1	1	1	H5117_005_0	3	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5126	1	0	1	1	1	H5126_001_0	4	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5126	1	0	1	1	1	H5126_001_0	4	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		30																			10		30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5126	1	0	1	1	1	H5126_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	40		120																			40		120																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5126	1	0	1	1	1	H5126_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	95		285																			95		285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5126	1	0	1	1	1	H5126_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				448.25	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5140	1	0	1	4	1	H5140_001_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		2																					2																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	1	0	1	4	1	H5140_001_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	9		9																					9																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	1	0	1	4	1	H5140_001_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	1	0	1	4	1	H5140_001_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	1	0	1	4	1	H5140_001_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	2	0	1	4	1	H5140_002_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		2																					2																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	2	0	1	4	1	H5140_002_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	9		9																					9																9				9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	2	0	1	4	1	H5140_002_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	2	0	1	4	1	H5140_002_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5140	2	0	1	4	1	H5140_002_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5141	1	0	1	4	1	H5141_001_0	10	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	1	0	1	4	1	H5141_001_0	10	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	1	0	1	4	1	H5141_001_0	10	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	1	0	1	4	1	H5141_001_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								95	190	285					85	170	255							170																95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	1	0	1	4	1	H5141_001_0	10	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2309.07	30	30	30				2309.07	30	30	30						30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	4	0	1	4	1	H5141_004_0	10	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	4	0	1	4	1	H5141_004_0	10	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	4	0	1	4	1	H5141_004_0	10	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	4	0	1	4	1	H5141_004_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								95	190	285					85	170	255							170																95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	4	0	1	4	1	H5141_004_0	10	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2182.6	30	30	30				2182.6	30	30	30						30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	7	0	1	4	1	H5141_007_0	10	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								10	20	30					0	0	0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	7	0	1	4	1	H5141_007_0	10	Generic	4	11	1	1	2	1		111	1	100		1				30	60	100	1	2			100				30		31											9.9	25	25	25				9.9	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	7	0	1	4	1	H5141_007_0	10	Preferred Brand	4	11	1	1	3	1		111	1	100		1				30	60	100	1	2			100				30		31											168.98	25	25	25				168.98	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	7	0	1	4	1	H5141_007_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	100		1				30	60	100	1	2			100				30		31											215.71	25	25	25				215.71	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	7	0	1	4	1	H5141_007_0	10	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2063.05	25	25	25				2063.05	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	25	0	1	4	1	H5141_025_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	25	0	1	4	1	H5141_025_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	25	0	1	4	1	H5141_025_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	25	0	1	4	1	H5141_025_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	25	0	1	4	1	H5141_025_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2225.68	33	33	33				2225.68	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	26	0	1	4	1	H5141_026_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	26	0	1	4	1	H5141_026_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	26	0	1	4	1	H5141_026_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	26	0	1	4	1	H5141_026_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	26	0	1	4	1	H5141_026_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2166.72	33	33	33				2166.72	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	32	0	1	4	1	H5141_032_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	32	0	1	4	1	H5141_032_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	32	0	1	4	1	H5141_032_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	32	0	1	4	1	H5141_032_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	32	0	1	4	1	H5141_032_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2217.54	33	33	33				2217.54	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	33	0	1	4	1	H5141_033_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	33	0	1	4	1	H5141_033_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	33	0	1	4	1	H5141_033_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	33	0	1	4	1	H5141_033_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	33	0	1	4	1	H5141_033_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2225.68	33	33	33				2225.68	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	34	0	1	4	1	H5141_034_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	34	0	1	4	1	H5141_034_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	34	0	1	4	1	H5141_034_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	34	0	1	4	1	H5141_034_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	34	0	1	4	1	H5141_034_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2245.83	33	33	33				2245.83	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	35	0	1	4	1	H5141_035_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	35	0	1	4	1	H5141_035_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	35	0	1	4	1	H5141_035_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	35	0	1	4	1	H5141_035_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								95	190	285					85	170	255							170																95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	35	0	1	4	1	H5141_035_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2182.6	33	33	33				2182.6	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	36	0	1	4	1	H5141_036_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	36	0	1	4	1	H5141_036_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	36	0	1	4	1	H5141_036_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	36	0	1	4	1	H5141_036_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	36	0	1	4	1	H5141_036_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2225.68	33	33	33				2225.68	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	37	0	1	4	1	H5141_037_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	37	0	1	4	1	H5141_037_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	37	0	1	4	1	H5141_037_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	37	0	1	4	1	H5141_037_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	37	0	1	4	1	H5141_037_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2245.83	33	33	33				2245.83	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	38	0	1	4	1	H5141_038_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	38	0	1	4	1	H5141_038_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	38	0	1	4	1	H5141_038_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	38	0	1	4	1	H5141_038_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	38	0	1	4	1	H5141_038_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2225.68	33	33	33				2225.68	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	39	0	1	4	1	H5141_039_0	10	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								12	24	36					0	0	0							0																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	39	0	1	4	1	H5141_039_0	10	Generic	4	11	1	1	2	1		111	1	100		1				30	60	100	1	2			100				30		31											9.9	25	25	25				9.9	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	39	0	1	4	1	H5141_039_0	10	Preferred Brand	4	11	1	1	3	1		111	1	100		1				30	60	100	1	2			100				30		31											168.98	25	25	25				168.98	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	39	0	1	4	1	H5141_039_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	100		1				30	60	100	1	2			100				30		31											215.71	25	25	25				215.71	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	39	0	1	4	1	H5141_039_0	10	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2063.05	25	25	25				2063.05	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	40	0	1	4	1	H5141_040_0	9	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	40	0	1	4	1	H5141_040_0	9	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								12	24	36					7	14	21							14																12				12			0.4	0.23				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	40	0	1	4	1	H5141_040_0	9	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	40	0	1	4	1	H5141_040_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								100	200	300					90	180	270							180																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	40	0	1	4	1	H5141_040_0	9	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2225.69	33	33	33				2225.69	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	42	0	1	4	1	H5141_042_0	10	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								12	24	36					0	0	0							0																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	42	0	1	4	1	H5141_042_0	10	Generic	4	11	1	1	2	1		111	1	100		1				30	60	100	1	2			100				30		31											9.91	25	25	25				9.91	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	42	0	1	4	1	H5141_042_0	10	Preferred Brand	4	11	1	1	3	1		111	1	100		1				30	60	100	1	2			100				30		31											169.05	25	25	25				169.05	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	42	0	1	4	1	H5141_042_0	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	100		1				30	60	100	1	2			100				30		31											215.05	25	25	25				215.05	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5141	42	0	1	4	1	H5141_042_0	10	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2061.53	25	25	25				2061.53	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5172	2	0	1	48	5	H5172_002_0	3	Generic Drugs	4	1			1	1	110		1	100		1	31		93				1	2			93				31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H5172	2	0	1	48	5	H5172_002_0	3	Brand Drugs	4	10			2	1	110		1	100		1	31		93				1	2			93				31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H5172	2	0	1	48	5	H5172_002_0	3	Non-Medicare Rx Drugs	4	11			3	1	110		1	100		1	31		93				1	2			93				31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H5172	2	0	1	48	5	H5172_002_0	3	Non-Medicare OTC Drugs	4	11			4	1	110		1	100		1	31		93				1	2			93				31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H5190	1	0	1	1	1	H5190_001_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	1	0	1	1	1	H5190_001_0	4	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	1	0	1	1	1	H5190_001_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	1	0	1	1	1	H5190_001_0	4	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	1	0	1	1	1	H5190_001_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	1	0	1	1	1	H5190_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	1	0	1	1	1	H5190_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	1	0	1	1	1	H5190_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	1	0	1	1	1	H5190_001_0	4	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	2	0	1	1	1	H5190_002_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	2	0	1	1	1	H5190_002_0	4	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	2	0	1	1	1	H5190_002_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	2	0	1	1	1	H5190_002_0	4	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	2	0	1	1	1	H5190_002_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	2	0	1	1	1	H5190_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	2	0	1	1	1	H5190_002_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	2	0	1	1	1	H5190_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	2	0	1	1	1	H5190_002_0	4	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	3	0	1	1	1	H5190_003_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	3	0	1	1	1	H5190_003_0	4	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	3	0	1	1	1	H5190_003_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	3	0	1	1	1	H5190_003_0	4	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	3	0	1	1	1	H5190_003_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	3	0	1	1	1	H5190_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	3	0	1	1	1	H5190_003_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	3	0	1	1	1	H5190_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	3	0	1	1	1	H5190_003_0	4	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	4	0	1	1	1	H5190_004_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	4	0	1	1	1	H5190_004_0	4	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	4	0	1	1	1	H5190_004_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	4	0	1	1	1	H5190_004_0	4	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5190	4	0	1	1	1	H5190_004_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	4	0	1	1	1	H5190_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	4	0	1	1	1	H5190_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	4	0	1	1	1	H5190_004_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5190	4	0	1	1	1	H5190_004_0	4	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5199	7	0	1	4	1	H5199_007_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	7	0	1	4	1	H5199_007_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5199	7	0	1	4	1	H5199_007_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	7	0	1	4	1	H5199_007_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	7	0	1	4	1	H5199_007_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	7	0	1	4	1	H5199_007_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					30																										30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	8	0	1	4	1	H5199_008_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	8	0	1	4	1	H5199_008_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5199	8	0	1	4	1	H5199_008_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	8	0	1	4	1	H5199_008_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	8	0	1	4	1	H5199_008_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	8	0	1	4	1	H5199_008_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	10	0	1	4	1	H5199_010_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	10	0	1	4	1	H5199_010_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5199	10	0	1	4	1	H5199_010_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	10	0	1	4	1	H5199_010_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	10	0	1	4	1	H5199_010_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	10	0	1	4	1	H5199_010_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	12	0	1	4	1	H5199_012_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	12	0	1	4	1	H5199_012_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5199	12	0	1	4	1	H5199_012_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	12	0	1	4	1	H5199_012_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	12	0	1	4	1	H5199_012_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	12	0	1	4	1	H5199_012_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	13	0	1	4	1	H5199_013_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	13	0	1	4	1	H5199_013_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5199	13	0	1	4	1	H5199_013_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	13	0	1	4	1	H5199_013_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	13	0	1	4	1	H5199_013_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5199	13	0	1	4	1	H5199_013_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5211	2	0	1	2	1	H5211_002_0	11	Preferred Generic	4	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	4	8	12																			4	8	12																4				4		0.12			0.12			0.11	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	2	0	1	2	1	H5211_002_0	11	Generic	4	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	12	24	36																			12	24	36																12				12		0.38			0.38			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	2	0	1	2	1	H5211_002_0	11	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	47	94	141																			47	94	141																47				47		1.52			1.52			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	2	0	1	2	1	H5211_002_0	11	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	100	200	300																			100	200	300																100				100		3.23			3.23			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	2	0	1	2	1	H5211_002_0	11	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		34				2061	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	2	0	1	2	1	H5211_002_0	11	Vaccines	4	11	1	2	6	1	10		1			1	31														31		34	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	4	0	1	2	1	H5211_004_0	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	9	18	27																			9	18	27																9				9		0.29			0.29			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	4	0	1	2	1	H5211_004_0	8	Generic	4	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	20	40	60																			20	40	60																20				20		0.65			0.65			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	4	0	1	2	1	H5211_004_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	47	94	141																			47	94	141																47				47		1.52			1.52			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	4	0	1	2	1	H5211_004_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	100	200	300																			100	200	300																100				100		3.23			3.23			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	4	0	1	2	1	H5211_004_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		34				2537	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	4	0	1	2	1	H5211_004_0	8	Vaccines	4	11	1	2	6	1	10		1			1	31														31		34	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	7	0	1	2	1	H5211_007_0	8	Preferred Generic	3	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	7	14	21																			7	14	21																7				7		0.23			0.23			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	7	0	1	2	1	H5211_007_0	8	Generic	3	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	20	40	60																			20	40	60																20				20		0.65			0.65			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	7	0	1	2	1	H5211_007_0	8	Preferred Brand	3	11	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	47	94	141																			47	94	141																47				47		1.52			1.52			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	7	0	1	2	1	H5211_007_0	8	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	100	200	300																			100	200	300																100				100		3.23			3.23			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	7	0	1	2	1	H5211_007_0	8	Specialty Tier	3	11	1	1	5	1	10		1	10		1	31								31						31		34				1831	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	7	0	1	2	1	H5211_007_0	8	Vaccines	3	11	1	2	6	1	10		1			1	31														31		34	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	8	0	1	2	1	H5211_008_0	8	Preferred Generic	3	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	8	16	24																			8	16	24																8				8		0.26			0.26			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	8	0	1	2	1	H5211_008_0	8	Generic	3	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	20	40	60																			20	40	60																20				20		0.65			0.65			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	8	0	1	2	1	H5211_008_0	8	Preferred Brand	3	11	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	47	94	141																			47	94	141																47				47		1.52			1.52			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	8	0	1	2	1	H5211_008_0	8	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	100	200	300																			100	200	300																100				100		3.23			3.23			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	8	0	1	2	1	H5211_008_0	8	Specialty Tier	3	11	1	1	5	1	10		1	10		1	31								31						31		34				2061	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	8	0	1	2	1	H5211_008_0	8	Vaccines	3	11	1	2	6	1	10		1			1	31														31		34	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	9	0	1	2	1	H5211_009_0	6	Preferred Generic	3	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	6	12	18																			6	12	18																6				6		0.19			0.19			0.17	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	9	0	1	2	1	H5211_009_0	6	Generic	3	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	20	40	60																			20	40	60																20				20		0.65			0.65			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	9	0	1	2	1	H5211_009_0	6	Preferred Brand	3	11	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	47	94	141																			47	94	141																47				47		1.52			1.52			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	9	0	1	2	1	H5211_009_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	100	200	300																			100	200	300																100				100		3.23			3.23			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	9	0	1	2	1	H5211_009_0	6	Specialty Tier	3	11	1	1	5	1	10		1	10		1	31								31						31		34				2219	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	9	0	1	2	1	H5211_009_0	6	Vaccines	3	11	1	2	6	1	10		1			1	31														31		34	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	12	0	1	2	1	H5211_012_0	8	Preferred Generic	3	1	1	2	1	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	6	12	18																			6	12	18																6				6		0.19			0.19			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	12	0	1	2	1	H5211_012_0	8	Generic	3	1	1	2	2	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	20	40	60																			20	40	60																20				20		0.65			0.65			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	12	0	1	2	1	H5211_012_0	8	Preferred Brand	3	11	1	2	3	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	47	94	141																			47	94	141																47				47		1.52			1.52			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	12	0	1	2	1	H5211_012_0	8	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	31	62	93				1	2	31	62	93				31		34	100	200	300																			100	200	300																100				100		3.23			3.23			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	12	0	1	2	1	H5211_012_0	8	Specialty Tier	3	11	1	1	5	1	10		1	10		1	31								31						31		34				2061	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5211	12	0	1	2	1	H5211_012_0	8	Vaccines	3	11	1	2	6	1	10		1			1	31														31		34	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5215	2	0	1	4	1	H5215_002_0	8	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								4		10					2		5					2		0																2				2			0.13	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	2	0	1	4	1	H5215_002_0	8	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								14		35					8		20					8		20																8				8			0.47	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	2	0	1	4	1	H5215_002_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	2	0	1	4	1	H5215_002_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								91		228					84		210					84		210																84				84			3.03	2.8	2.8			2.71	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	2	0	1	4	1	H5215_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	5	0	1	4	1	H5215_005_0	8	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								4		10					2		5					2		0																2				2			0.13	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	5	0	1	4	1	H5215_005_0	8	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								14		35					8		20					8		20																8				8			0.47	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	5	0	1	4	1	H5215_005_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	5	0	1	4	1	H5215_005_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								91		228					84		210					84		210																84				84			3.03	2.8	2.8			2.71	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	5	0	1	4	1	H5215_005_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	7	0	1	4	1	H5215_007_0	10	Preferred Generic	3	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		15					4		10					4		0																4				4			0.2	0.13	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	7	0	1	4	1	H5215_007_0	10	Generic	3	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					9		23					9		23																9				9			0.5	0.3	0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	7	0	1	4	1	H5215_007_0	10	Preferred Brand	3	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	7	0	1	4	1	H5215_007_0	10	Non-Preferred Brand	3	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		250					94		235					94		235																94				94			3.33	3.13	3.13			3.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	7	0	1	4	1	H5215_007_0	10	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	8	0	1	4	1	H5215_008_0	8	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								4		10					2		5					2		0																2				2			0.13	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	8	0	1	4	1	H5215_008_0	8	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								14		35					8		20					8		20																8				8			0.47	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	8	0	1	4	1	H5215_008_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	8	0	1	4	1	H5215_008_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								91		228					84		210					84		210																84				84			3.03	2.8	2.8			2.71	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	8	0	1	4	1	H5215_008_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	9	0	1	4	1	H5215_009_0	8	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								4		10					2		5					2		0																2				2			0.13	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	9	0	1	4	1	H5215_009_0	8	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								14		35					8		20					8		20																8				8			0.47	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	9	0	1	4	1	H5215_009_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	9	0	1	4	1	H5215_009_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								91		228					84		210					84		210																84				84			3.03	2.8	2.8			2.71	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	9	0	1	4	1	H5215_009_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	10	0	1	4	1	H5215_010_0	8	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								4		10					2		5					2		0																2				2			0.13	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	10	0	1	4	1	H5215_010_0	8	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								14		35					8		20					8		20																8				8			0.47	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	10	0	1	4	1	H5215_010_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	10	0	1	4	1	H5215_010_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								91		228					84		210					84		210																84				84			3.03	2.8	2.8			2.71	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	10	0	1	4	1	H5215_010_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	11	0	1	4	1	H5215_011_0	8	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								4		10					2		5					2		0																2				2			0.13	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	11	0	1	4	1	H5215_011_0	8	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								14		35					8		20					8		20																8				8			0.47	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	11	0	1	4	1	H5215_011_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	11	0	1	4	1	H5215_011_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								91		228					84		210					84		210																84				84			3.03	2.8	2.8			2.71	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5215	11	0	1	4	1	H5215_011_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5216	1	0	1	4	1	H5216_001_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	1	0	1	4	1	H5216_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	1	0	1	4	1	H5216_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	1	0	1	4	1	H5216_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	1	0	1	4	1	H5216_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	6	0	1	4	1	H5216_006_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	6	0	1	4	1	H5216_006_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	6	0	1	4	1	H5216_006_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	6	0	1	4	1	H5216_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	6	0	1	4	1	H5216_006_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	9	0	1	4	1	H5216_009_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	9	0	1	4	1	H5216_009_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	9	0	1	4	1	H5216_009_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	9	0	1	4	1	H5216_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	9	0	1	4	1	H5216_009_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	11	0	1	4	1	H5216_011_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	11	0	1	4	1	H5216_011_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	11	0	1	4	1	H5216_011_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	11	0	1	4	1	H5216_011_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	11	0	1	4	1	H5216_011_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	13	0	1	4	1	H5216_013_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	13	0	1	4	1	H5216_013_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	13	0	1	4	1	H5216_013_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	13	0	1	4	1	H5216_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	13	0	1	4	1	H5216_013_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	14	0	1	4	1	H5216_014_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	14	0	1	4	1	H5216_014_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	14	0	1	4	1	H5216_014_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	14	0	1	4	1	H5216_014_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											50	50		50				50	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	14	0	1	4	1	H5216_014_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	17	0	1	4	1	H5216_017_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	17	0	1	4	1	H5216_017_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	17	0	1	4	1	H5216_017_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	17	0	1	4	1	H5216_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	17	0	1	4	1	H5216_017_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	18	0	1	4	1	H5216_018_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	18	0	1	4	1	H5216_018_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	18	0	1	4	1	H5216_018_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	18	0	1	4	1	H5216_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	18	0	1	4	1	H5216_018_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	19	0	1	4	1	H5216_019_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	19	0	1	4	1	H5216_019_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	19	0	1	4	1	H5216_019_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	19	0	1	4	1	H5216_019_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	19	0	1	4	1	H5216_019_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	20	0	1	4	1	H5216_020_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	20	0	1	4	1	H5216_020_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	20	0	1	4	1	H5216_020_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	20	0	1	4	1	H5216_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	20	0	1	4	1	H5216_020_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	21	0	1	4	1	H5216_021_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	21	0	1	4	1	H5216_021_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	21	0	1	4	1	H5216_021_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	21	0	1	4	1	H5216_021_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	21	0	1	4	1	H5216_021_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	22	0	1	4	1	H5216_022_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	22	0	1	4	1	H5216_022_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	22	0	1	4	1	H5216_022_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	22	0	1	4	1	H5216_022_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	22	0	1	4	1	H5216_022_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	23	0	1	4	1	H5216_023_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	23	0	1	4	1	H5216_023_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	23	0	1	4	1	H5216_023_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	23	0	1	4	1	H5216_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	23	0	1	4	1	H5216_023_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	24	0	1	4	1	H5216_024_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	24	0	1	4	1	H5216_024_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	24	0	1	4	1	H5216_024_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	24	0	1	4	1	H5216_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	24	0	1	4	1	H5216_024_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	27	0	1	4	1	H5216_027_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	27	0	1	4	1	H5216_027_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	27	0	1	4	1	H5216_027_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	27	0	1	4	1	H5216_027_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	27	0	1	4	1	H5216_027_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	28	0	1	4	1	H5216_028_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	28	0	1	4	1	H5216_028_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	28	0	1	4	1	H5216_028_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	28	0	1	4	1	H5216_028_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	28	0	1	4	1	H5216_028_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	29	0	1	4	1	H5216_029_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	29	0	1	4	1	H5216_029_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	29	0	1	4	1	H5216_029_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	29	0	1	4	1	H5216_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	29	0	1	4	1	H5216_029_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	32	0	1	4	1	H5216_032_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	32	0	1	4	1	H5216_032_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	32	0	1	4	1	H5216_032_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	32	0	1	4	1	H5216_032_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	32	0	1	4	1	H5216_032_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	1	1	4	1	H5216_033_1	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	1	1	4	1	H5216_033_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	1	1	4	1	H5216_033_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	1	1	4	1	H5216_033_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	1	1	4	1	H5216_033_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	2	1	4	1	H5216_033_2	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	2	1	4	1	H5216_033_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	2	1	4	1	H5216_033_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	2	1	4	1	H5216_033_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	33	2	1	4	1	H5216_033_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	34	0	1	4	1	H5216_034_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	34	0	1	4	1	H5216_034_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	34	0	1	4	1	H5216_034_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	34	0	1	4	1	H5216_034_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	34	0	1	4	1	H5216_034_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	35	0	1	4	1	H5216_035_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	35	0	1	4	1	H5216_035_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	35	0	1	4	1	H5216_035_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	35	0	1	4	1	H5216_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	35	0	1	4	1	H5216_035_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	36	0	1	4	1	H5216_036_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	36	0	1	4	1	H5216_036_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					7		21											20		60				7		0				20				20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	36	0	1	4	1	H5216_036_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	36	0	1	4	1	H5216_036_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	36	0	1	4	1	H5216_036_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	37	0	1	4	1	H5216_037_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	37	0	1	4	1	H5216_037_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	37	0	1	4	1	H5216_037_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	37	0	1	4	1	H5216_037_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	37	0	1	4	1	H5216_037_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	39	0	1	4	1	H5216_039_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	39	0	1	4	1	H5216_039_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					14		42											20		60				14		0				20				20			0.67	0.47		0.67	0.47	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	39	0	1	4	1	H5216_039_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	39	0	1	4	1	H5216_039_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	39	0	1	4	1	H5216_039_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	40	0	1	4	1	H5216_040_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	40	0	1	4	1	H5216_040_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	40	0	1	4	1	H5216_040_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	40	0	1	4	1	H5216_040_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	40	0	1	4	1	H5216_040_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	41	0	1	4	1	H5216_041_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	41	0	1	4	1	H5216_041_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	41	0	1	4	1	H5216_041_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	41	0	1	4	1	H5216_041_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	41	0	1	4	1	H5216_041_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	42	0	1	4	1	H5216_042_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	42	0	1	4	1	H5216_042_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	42	0	1	4	1	H5216_042_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	42	0	1	4	1	H5216_042_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	42	0	1	4	1	H5216_042_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	1	1	4	1	H5216_043_1	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	1	1	4	1	H5216_043_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	1	1	4	1	H5216_043_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	1	1	4	1	H5216_043_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	1	1	4	1	H5216_043_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	2	1	4	1	H5216_043_2	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	2	1	4	1	H5216_043_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	2	1	4	1	H5216_043_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	2	1	4	1	H5216_043_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	43	2	1	4	1	H5216_043_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	44	0	1	4	1	H5216_044_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	44	0	1	4	1	H5216_044_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	44	0	1	4	1	H5216_044_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	44	0	1	4	1	H5216_044_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	44	0	1	4	1	H5216_044_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	45	0	1	4	1	H5216_045_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	45	0	1	4	1	H5216_045_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	45	0	1	4	1	H5216_045_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	45	0	1	4	1	H5216_045_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	45	0	1	4	1	H5216_045_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	47	0	1	4	1	H5216_047_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	47	0	1	4	1	H5216_047_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	47	0	1	4	1	H5216_047_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	47	0	1	4	1	H5216_047_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	47	0	1	4	1	H5216_047_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	48	0	1	4	1	H5216_048_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								18		54					16		48											18		54				16		0				18				18			0.6	0.53		0.6	0.53	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	48	0	1	4	1	H5216_048_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					18		54											20		60				18		0				20				20			0.67	0.6		0.67	0.6	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	48	0	1	4	1	H5216_048_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	48	0	1	4	1	H5216_048_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	48	0	1	4	1	H5216_048_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	50	0	1	4	1	H5216_050_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	50	0	1	4	1	H5216_050_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	50	0	1	4	1	H5216_050_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	50	0	1	4	1	H5216_050_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	50	0	1	4	1	H5216_050_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	51	0	1	4	1	H5216_051_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	51	0	1	4	1	H5216_051_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	51	0	1	4	1	H5216_051_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	51	0	1	4	1	H5216_051_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	51	0	1	4	1	H5216_051_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	1	1	4	1	H5216_052_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	1	1	4	1	H5216_052_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	1	1	4	1	H5216_052_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	1	1	4	1	H5216_052_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	1	1	4	1	H5216_052_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	2	1	4	1	H5216_052_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	2	1	4	1	H5216_052_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	2	1	4	1	H5216_052_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	2	1	4	1	H5216_052_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	52	2	1	4	1	H5216_052_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	53	0	1	4	1	H5216_053_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	53	0	1	4	1	H5216_053_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	53	0	1	4	1	H5216_053_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	53	0	1	4	1	H5216_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	53	0	1	4	1	H5216_053_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	54	0	1	4	1	H5216_054_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	54	0	1	4	1	H5216_054_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	54	0	1	4	1	H5216_054_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	54	0	1	4	1	H5216_054_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	54	0	1	4	1	H5216_054_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	55	0	1	4	1	H5216_055_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	55	0	1	4	1	H5216_055_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	55	0	1	4	1	H5216_055_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	55	0	1	4	1	H5216_055_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	55	0	1	4	1	H5216_055_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	57	0	1	4	1	H5216_057_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	57	0	1	4	1	H5216_057_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	57	0	1	4	1	H5216_057_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	57	0	1	4	1	H5216_057_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	57	0	1	4	1	H5216_057_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	58	0	1	4	1	H5216_058_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	58	0	1	4	1	H5216_058_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	58	0	1	4	1	H5216_058_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	58	0	1	4	1	H5216_058_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	58	0	1	4	1	H5216_058_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	61	0	1	4	1	H5216_061_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	61	0	1	4	1	H5216_061_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	61	0	1	4	1	H5216_061_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	61	0	1	4	1	H5216_061_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	61	0	1	4	1	H5216_061_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	62	0	1	4	1	H5216_062_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	62	0	1	4	1	H5216_062_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	62	0	1	4	1	H5216_062_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	62	0	1	4	1	H5216_062_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	62	0	1	4	1	H5216_062_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	63	0	1	4	1	H5216_063_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	63	0	1	4	1	H5216_063_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	63	0	1	4	1	H5216_063_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	63	0	1	4	1	H5216_063_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											41	50		50				41	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	63	0	1	4	1	H5216_063_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	64	0	1	4	1	H5216_064_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	64	0	1	4	1	H5216_064_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	64	0	1	4	1	H5216_064_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	64	0	1	4	1	H5216_064_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	64	0	1	4	1	H5216_064_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	65	0	1	4	1	H5216_065_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	65	0	1	4	1	H5216_065_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	65	0	1	4	1	H5216_065_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	65	0	1	4	1	H5216_065_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	65	0	1	4	1	H5216_065_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	66	0	1	4	1	H5216_066_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	66	0	1	4	1	H5216_066_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	66	0	1	4	1	H5216_066_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	66	0	1	4	1	H5216_066_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	66	0	1	4	1	H5216_066_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	67	0	1	4	1	H5216_067_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	67	0	1	4	1	H5216_067_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	67	0	1	4	1	H5216_067_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	67	0	1	4	1	H5216_067_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	67	0	1	4	1	H5216_067_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	68	0	1	4	1	H5216_068_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	68	0	1	4	1	H5216_068_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	68	0	1	4	1	H5216_068_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	68	0	1	4	1	H5216_068_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	68	0	1	4	1	H5216_068_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	70	0	1	4	1	H5216_070_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	70	0	1	4	1	H5216_070_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	70	0	1	4	1	H5216_070_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	70	0	1	4	1	H5216_070_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	70	0	1	4	1	H5216_070_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	71	0	1	4	1	H5216_071_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	71	0	1	4	1	H5216_071_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	71	0	1	4	1	H5216_071_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	71	0	1	4	1	H5216_071_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	71	0	1	4	1	H5216_071_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	72	0	1	4	1	H5216_072_0	7	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	72	0	1	4	1	H5216_072_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	72	0	1	4	1	H5216_072_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	72	0	1	4	1	H5216_072_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	72	0	1	4	1	H5216_072_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	73	0	1	4	1	H5216_073_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	73	0	1	4	1	H5216_073_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	73	0	1	4	1	H5216_073_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	73	0	1	4	1	H5216_073_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	73	0	1	4	1	H5216_073_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	74	0	1	4	1	H5216_074_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	74	0	1	4	1	H5216_074_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	74	0	1	4	1	H5216_074_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	74	0	1	4	1	H5216_074_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	74	0	1	4	1	H5216_074_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	75	0	1	4	1	H5216_075_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	75	0	1	4	1	H5216_075_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	75	0	1	4	1	H5216_075_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	75	0	1	4	1	H5216_075_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	75	0	1	4	1	H5216_075_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	76	0	1	4	1	H5216_076_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	76	0	1	4	1	H5216_076_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	76	0	1	4	1	H5216_076_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	76	0	1	4	1	H5216_076_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	76	0	1	4	1	H5216_076_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	1	1	4	1	H5216_078_1	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	1	1	4	1	H5216_078_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	1	1	4	1	H5216_078_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	1	1	4	1	H5216_078_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	1	1	4	1	H5216_078_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	2	1	4	1	H5216_078_2	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	2	1	4	1	H5216_078_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	2	1	4	1	H5216_078_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	2	1	4	1	H5216_078_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	78	2	1	4	1	H5216_078_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	1	1	4	1	H5216_080_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	1	1	4	1	H5216_080_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	1	1	4	1	H5216_080_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	1	1	4	1	H5216_080_1	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											102	50		50				93	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	1	1	4	1	H5216_080_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	2	1	4	1	H5216_080_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	2	1	4	1	H5216_080_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	2	1	4	1	H5216_080_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	2	1	4	1	H5216_080_2	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											102	50		50				93	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	2	1	4	1	H5216_080_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	3	1	4	1	H5216_080_3	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	3	1	4	1	H5216_080_3	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	3	1	4	1	H5216_080_3	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	3	1	4	1	H5216_080_3	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											102	50		50				93	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	80	3	1	4	1	H5216_080_3	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	81	0	1	4	1	H5216_081_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	81	0	1	4	1	H5216_081_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	81	0	1	4	1	H5216_081_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	81	0	1	4	1	H5216_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	81	0	1	4	1	H5216_081_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	83	0	1	4	1	H5216_083_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	83	0	1	4	1	H5216_083_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	83	0	1	4	1	H5216_083_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	83	0	1	4	1	H5216_083_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	83	0	1	4	1	H5216_083_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	85	0	1	4	1	H5216_085_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	85	0	1	4	1	H5216_085_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	85	0	1	4	1	H5216_085_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	85	0	1	4	1	H5216_085_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											49	45		45				49	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	85	0	1	4	1	H5216_085_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	88	0	1	4	1	H5216_088_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	88	0	1	4	1	H5216_088_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	88	0	1	4	1	H5216_088_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	88	0	1	4	1	H5216_088_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											60	50		50				60	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	88	0	1	4	1	H5216_088_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	89	0	1	4	1	H5216_089_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	89	0	1	4	1	H5216_089_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	89	0	1	4	1	H5216_089_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	89	0	1	4	1	H5216_089_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											52	50		50				52	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	89	0	1	4	1	H5216_089_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	91	0	1	4	1	H5216_091_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	91	0	1	4	1	H5216_091_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	91	0	1	4	1	H5216_091_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	91	0	1	4	1	H5216_091_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											55	50		50				55	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	91	0	1	4	1	H5216_091_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	92	0	1	4	1	H5216_092_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	92	0	1	4	1	H5216_092_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	92	0	1	4	1	H5216_092_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	92	0	1	4	1	H5216_092_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											56	50		50				56	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	92	0	1	4	1	H5216_092_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	93	0	1	4	1	H5216_093_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	93	0	1	4	1	H5216_093_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	93	0	1	4	1	H5216_093_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	93	0	1	4	1	H5216_093_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	93	0	1	4	1	H5216_093_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	96	0	1	4	1	H5216_096_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	96	0	1	4	1	H5216_096_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	96	0	1	4	1	H5216_096_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	96	0	1	4	1	H5216_096_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	96	0	1	4	1	H5216_096_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	97	0	1	4	1	H5216_097_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	97	0	1	4	1	H5216_097_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	97	0	1	4	1	H5216_097_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	97	0	1	4	1	H5216_097_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	97	0	1	4	1	H5216_097_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	98	0	1	4	1	H5216_098_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	98	0	1	4	1	H5216_098_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	98	0	1	4	1	H5216_098_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	98	0	1	4	1	H5216_098_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	98	0	1	4	1	H5216_098_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	99	0	1	4	1	H5216_099_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	99	0	1	4	1	H5216_099_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	99	0	1	4	1	H5216_099_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	99	0	1	4	1	H5216_099_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	99	0	1	4	1	H5216_099_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	100	0	1	4	1	H5216_100_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	100	0	1	4	1	H5216_100_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	100	0	1	4	1	H5216_100_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	100	0	1	4	1	H5216_100_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	100	0	1	4	1	H5216_100_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	103	0	1	4	1	H5216_103_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	103	0	1	4	1	H5216_103_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	103	0	1	4	1	H5216_103_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	103	0	1	4	1	H5216_103_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											61	50		50				61	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	103	0	1	4	1	H5216_103_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	106	0	1	4	1	H5216_106_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	106	0	1	4	1	H5216_106_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	106	0	1	4	1	H5216_106_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	106	0	1	4	1	H5216_106_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	106	0	1	4	1	H5216_106_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	107	0	1	4	1	H5216_107_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	107	0	1	4	1	H5216_107_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	107	0	1	4	1	H5216_107_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	107	0	1	4	1	H5216_107_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	107	0	1	4	1	H5216_107_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	109	0	1	4	1	H5216_109_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	109	0	1	4	1	H5216_109_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	109	0	1	4	1	H5216_109_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	109	0	1	4	1	H5216_109_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	109	0	1	4	1	H5216_109_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	111	0	1	4	1	H5216_111_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	111	0	1	4	1	H5216_111_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	111	0	1	4	1	H5216_111_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	111	0	1	4	1	H5216_111_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	111	0	1	4	1	H5216_111_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	112	0	1	4	1	H5216_112_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	112	0	1	4	1	H5216_112_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	112	0	1	4	1	H5216_112_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	112	0	1	4	1	H5216_112_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	112	0	1	4	1	H5216_112_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	114	0	1	4	1	H5216_114_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	114	0	1	4	1	H5216_114_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	114	0	1	4	1	H5216_114_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	114	0	1	4	1	H5216_114_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	114	0	1	4	1	H5216_114_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	115	0	1	4	1	H5216_115_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	115	0	1	4	1	H5216_115_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	115	0	1	4	1	H5216_115_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	115	0	1	4	1	H5216_115_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	115	0	1	4	1	H5216_115_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	117	0	1	4	1	H5216_117_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	117	0	1	4	1	H5216_117_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	117	0	1	4	1	H5216_117_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	117	0	1	4	1	H5216_117_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	117	0	1	4	1	H5216_117_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	119	0	1	4	1	H5216_119_0	6	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	119	0	1	4	1	H5216_119_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	119	0	1	4	1	H5216_119_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	119	0	1	4	1	H5216_119_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	119	0	1	4	1	H5216_119_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	120	0	1	4	1	H5216_120_0	7	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	120	0	1	4	1	H5216_120_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	120	0	1	4	1	H5216_120_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	120	0	1	4	1	H5216_120_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	120	0	1	4	1	H5216_120_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	122	0	1	4	1	H5216_122_0	6	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	122	0	1	4	1	H5216_122_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	122	0	1	4	1	H5216_122_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	122	0	1	4	1	H5216_122_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	122	0	1	4	1	H5216_122_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	124	0	1	4	1	H5216_124_0	6	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	124	0	1	4	1	H5216_124_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	124	0	1	4	1	H5216_124_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	124	0	1	4	1	H5216_124_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	124	0	1	4	1	H5216_124_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	125	0	1	4	1	H5216_125_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	125	0	1	4	1	H5216_125_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	125	0	1	4	1	H5216_125_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	125	0	1	4	1	H5216_125_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	125	0	1	4	1	H5216_125_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	131	0	1	4	1	H5216_131_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	131	0	1	4	1	H5216_131_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	131	0	1	4	1	H5216_131_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	131	0	1	4	1	H5216_131_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	131	0	1	4	1	H5216_131_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	132	0	1	4	1	H5216_132_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	132	0	1	4	1	H5216_132_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	132	0	1	4	1	H5216_132_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	132	0	1	4	1	H5216_132_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	132	0	1	4	1	H5216_132_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	133	0	1	4	1	H5216_133_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	133	0	1	4	1	H5216_133_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	133	0	1	4	1	H5216_133_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	133	0	1	4	1	H5216_133_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	133	0	1	4	1	H5216_133_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	136	0	1	4	1	H5216_136_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	136	0	1	4	1	H5216_136_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	136	0	1	4	1	H5216_136_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	136	0	1	4	1	H5216_136_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	136	0	1	4	1	H5216_136_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	137	0	1	4	1	H5216_137_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	137	0	1	4	1	H5216_137_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	137	0	1	4	1	H5216_137_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	137	0	1	4	1	H5216_137_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	137	0	1	4	1	H5216_137_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	138	0	1	4	1	H5216_138_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	138	0	1	4	1	H5216_138_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	138	0	1	4	1	H5216_138_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	138	0	1	4	1	H5216_138_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	138	0	1	4	1	H5216_138_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	139	0	1	4	1	H5216_139_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	139	0	1	4	1	H5216_139_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	139	0	1	4	1	H5216_139_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	139	0	1	4	1	H5216_139_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	139	0	1	4	1	H5216_139_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	141	0	1	4	1	H5216_141_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	141	0	1	4	1	H5216_141_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	141	0	1	4	1	H5216_141_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	141	0	1	4	1	H5216_141_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	141	0	1	4	1	H5216_141_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	1	1	4	1	H5216_142_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	1	1	4	1	H5216_142_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	1	1	4	1	H5216_142_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	1	1	4	1	H5216_142_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	1	1	4	1	H5216_142_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	2	1	4	1	H5216_142_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	2	1	4	1	H5216_142_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	2	1	4	1	H5216_142_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	2	1	4	1	H5216_142_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	142	2	1	4	1	H5216_142_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	143	0	1	4	1	H5216_143_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	143	0	1	4	1	H5216_143_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	143	0	1	4	1	H5216_143_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	143	0	1	4	1	H5216_143_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	143	0	1	4	1	H5216_143_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	144	0	1	4	1	H5216_144_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	144	0	1	4	1	H5216_144_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	144	0	1	4	1	H5216_144_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	144	0	1	4	1	H5216_144_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	144	0	1	4	1	H5216_144_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	145	0	1	4	1	H5216_145_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	145	0	1	4	1	H5216_145_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	145	0	1	4	1	H5216_145_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	145	0	1	4	1	H5216_145_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	145	0	1	4	1	H5216_145_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	148	0	1	4	1	H5216_148_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	148	0	1	4	1	H5216_148_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	148	0	1	4	1	H5216_148_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	148	0	1	4	1	H5216_148_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	148	0	1	4	1	H5216_148_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	149	0	1	4	1	H5216_149_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	149	0	1	4	1	H5216_149_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	149	0	1	4	1	H5216_149_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	149	0	1	4	1	H5216_149_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	149	0	1	4	1	H5216_149_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	154	0	1	4	1	H5216_154_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	154	0	1	4	1	H5216_154_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	154	0	1	4	1	H5216_154_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	154	0	1	4	1	H5216_154_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	154	0	1	4	1	H5216_154_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	155	0	1	4	1	H5216_155_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	155	0	1	4	1	H5216_155_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	155	0	1	4	1	H5216_155_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	155	0	1	4	1	H5216_155_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	155	0	1	4	1	H5216_155_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	156	0	1	4	1	H5216_156_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	156	0	1	4	1	H5216_156_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	156	0	1	4	1	H5216_156_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	156	0	1	4	1	H5216_156_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	156	0	1	4	1	H5216_156_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	158	0	1	4	1	H5216_158_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	158	0	1	4	1	H5216_158_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	158	0	1	4	1	H5216_158_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	158	0	1	4	1	H5216_158_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	158	0	1	4	1	H5216_158_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	159	0	1	4	1	H5216_159_0	5	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	159	0	1	4	1	H5216_159_0	5	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	159	0	1	4	1	H5216_159_0	5	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	159	0	1	4	1	H5216_159_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	159	0	1	4	1	H5216_159_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	160	0	1	4	1	H5216_160_0	5	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	160	0	1	4	1	H5216_160_0	5	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	160	0	1	4	1	H5216_160_0	5	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	160	0	1	4	1	H5216_160_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	160	0	1	4	1	H5216_160_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	161	0	1	4	1	H5216_161_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	161	0	1	4	1	H5216_161_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	161	0	1	4	1	H5216_161_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	161	0	1	4	1	H5216_161_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	161	0	1	4	1	H5216_161_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	163	0	1	4	1	H5216_163_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	163	0	1	4	1	H5216_163_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	163	0	1	4	1	H5216_163_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	163	0	1	4	1	H5216_163_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	163	0	1	4	1	H5216_163_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	164	0	1	4	1	H5216_164_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	164	0	1	4	1	H5216_164_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	164	0	1	4	1	H5216_164_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	164	0	1	4	1	H5216_164_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	164	0	1	4	1	H5216_164_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	165	0	1	4	1	H5216_165_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	165	0	1	4	1	H5216_165_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					18		54											20		60				18		0				20				20			0.67	0.6		0.67	0.6	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	165	0	1	4	1	H5216_165_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	165	0	1	4	1	H5216_165_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	165	0	1	4	1	H5216_165_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	166	0	1	4	1	H5216_166_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	166	0	1	4	1	H5216_166_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	166	0	1	4	1	H5216_166_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	166	0	1	4	1	H5216_166_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	166	0	1	4	1	H5216_166_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	167	0	1	4	1	H5216_167_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	167	0	1	4	1	H5216_167_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	167	0	1	4	1	H5216_167_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	167	0	1	4	1	H5216_167_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											66	50		50				66	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	167	0	1	4	1	H5216_167_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	168	0	1	4	1	H5216_168_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	168	0	1	4	1	H5216_168_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	168	0	1	4	1	H5216_168_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	168	0	1	4	1	H5216_168_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											55	50		50				55	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	168	0	1	4	1	H5216_168_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	169	0	1	4	1	H5216_169_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	169	0	1	4	1	H5216_169_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	169	0	1	4	1	H5216_169_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	169	0	1	4	1	H5216_169_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	169	0	1	4	1	H5216_169_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	170	0	1	4	1	H5216_170_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	170	0	1	4	1	H5216_170_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	170	0	1	4	1	H5216_170_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	170	0	1	4	1	H5216_170_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	170	0	1	4	1	H5216_170_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	171	0	1	4	1	H5216_171_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	171	0	1	4	1	H5216_171_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	171	0	1	4	1	H5216_171_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	171	0	1	4	1	H5216_171_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	171	0	1	4	1	H5216_171_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	172	0	1	4	1	H5216_172_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	172	0	1	4	1	H5216_172_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	172	0	1	4	1	H5216_172_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	172	0	1	4	1	H5216_172_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	172	0	1	4	1	H5216_172_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	173	0	1	4	1	H5216_173_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					9		27											10		30				9		0				10				10			0.33	0.3		0.33	0.3	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	173	0	1	4	1	H5216_173_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	173	0	1	4	1	H5216_173_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	173	0	1	4	1	H5216_173_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	173	0	1	4	1	H5216_173_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	175	0	1	4	1	H5216_175_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	175	0	1	4	1	H5216_175_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	175	0	1	4	1	H5216_175_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	175	0	1	4	1	H5216_175_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	175	0	1	4	1	H5216_175_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	176	0	1	4	1	H5216_176_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					14		42											15		45				14		0				15				15			0.5	0.47		0.5	0.47	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	176	0	1	4	1	H5216_176_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	176	0	1	4	1	H5216_176_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	176	0	1	4	1	H5216_176_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	176	0	1	4	1	H5216_176_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	177	0	1	4	1	H5216_177_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	177	0	1	4	1	H5216_177_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	177	0	1	4	1	H5216_177_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	177	0	1	4	1	H5216_177_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	177	0	1	4	1	H5216_177_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	179	0	1	4	1	H5216_179_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	179	0	1	4	1	H5216_179_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	179	0	1	4	1	H5216_179_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	179	0	1	4	1	H5216_179_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	179	0	1	4	1	H5216_179_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	180	0	1	4	1	H5216_180_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	180	0	1	4	1	H5216_180_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	180	0	1	4	1	H5216_180_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	180	0	1	4	1	H5216_180_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	180	0	1	4	1	H5216_180_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	181	0	1	4	1	H5216_181_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	181	0	1	4	1	H5216_181_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	181	0	1	4	1	H5216_181_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	181	0	1	4	1	H5216_181_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	181	0	1	4	1	H5216_181_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	182	0	1	4	1	H5216_182_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	182	0	1	4	1	H5216_182_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	182	0	1	4	1	H5216_182_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	182	0	1	4	1	H5216_182_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	182	0	1	4	1	H5216_182_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	184	0	1	4	1	H5216_184_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	184	0	1	4	1	H5216_184_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	184	0	1	4	1	H5216_184_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	184	0	1	4	1	H5216_184_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	184	0	1	4	1	H5216_184_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	185	0	1	4	1	H5216_185_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	185	0	1	4	1	H5216_185_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	185	0	1	4	1	H5216_185_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	185	0	1	4	1	H5216_185_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	185	0	1	4	1	H5216_185_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	186	0	1	4	1	H5216_186_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	186	0	1	4	1	H5216_186_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	186	0	1	4	1	H5216_186_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	186	0	1	4	1	H5216_186_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	186	0	1	4	1	H5216_186_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	188	0	1	4	1	H5216_188_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	188	0	1	4	1	H5216_188_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	188	0	1	4	1	H5216_188_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	188	0	1	4	1	H5216_188_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	188	0	1	4	1	H5216_188_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	189	0	1	4	1	H5216_189_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	189	0	1	4	1	H5216_189_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	189	0	1	4	1	H5216_189_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	189	0	1	4	1	H5216_189_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	189	0	1	4	1	H5216_189_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	192	0	1	4	1	H5216_192_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	192	0	1	4	1	H5216_192_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	192	0	1	4	1	H5216_192_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	192	0	1	4	1	H5216_192_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	192	0	1	4	1	H5216_192_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	193	0	1	4	1	H5216_193_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	193	0	1	4	1	H5216_193_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	193	0	1	4	1	H5216_193_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	193	0	1	4	1	H5216_193_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	193	0	1	4	1	H5216_193_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	194	0	1	4	1	H5216_194_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	194	0	1	4	1	H5216_194_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	194	0	1	4	1	H5216_194_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	194	0	1	4	1	H5216_194_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	194	0	1	4	1	H5216_194_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	195	0	1	4	1	H5216_195_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	195	0	1	4	1	H5216_195_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					14		42											20		60				14		0				20				20			0.67	0.47		0.67	0.47	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	195	0	1	4	1	H5216_195_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	195	0	1	4	1	H5216_195_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											61	50		50				48	40		40										50		50				40		40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	195	0	1	4	1	H5216_195_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	1	1	4	1	H5216_196_1	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	1	1	4	1	H5216_196_1	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	1	1	4	1	H5216_196_1	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	1	1	4	1	H5216_196_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	1	1	4	1	H5216_196_1	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	2	1	4	1	H5216_196_2	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	2	1	4	1	H5216_196_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	2	1	4	1	H5216_196_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	2	1	4	1	H5216_196_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	196	2	1	4	1	H5216_196_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	197	0	1	4	1	H5216_197_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	197	0	1	4	1	H5216_197_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	197	0	1	4	1	H5216_197_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	197	0	1	4	1	H5216_197_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											61	50		50				61	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	197	0	1	4	1	H5216_197_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	198	0	1	4	1	H5216_198_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	198	0	1	4	1	H5216_198_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	198	0	1	4	1	H5216_198_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	198	0	1	4	1	H5216_198_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	198	0	1	4	1	H5216_198_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	199	0	1	4	1	H5216_199_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	199	0	1	4	1	H5216_199_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	199	0	1	4	1	H5216_199_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	199	0	1	4	1	H5216_199_0	3	Non-Preferred Drug	3	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											66	50		50				66	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	199	0	1	4	1	H5216_199_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	202	0	1	4	1	H5216_202_0	8	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	202	0	1	4	1	H5216_202_0	8	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	202	0	1	4	1	H5216_202_0	8	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	202	0	1	4	1	H5216_202_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	202	0	1	4	1	H5216_202_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	1	1	4	1	H5216_203_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	1	1	4	1	H5216_203_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	1	1	4	1	H5216_203_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	1	1	4	1	H5216_203_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	1	1	4	1	H5216_203_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	2	1	4	1	H5216_203_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	2	1	4	1	H5216_203_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	2	1	4	1	H5216_203_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	2	1	4	1	H5216_203_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	203	2	1	4	1	H5216_203_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	204	0	1	4	1	H5216_204_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	204	0	1	4	1	H5216_204_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	204	0	1	4	1	H5216_204_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	204	0	1	4	1	H5216_204_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	204	0	1	4	1	H5216_204_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	205	0	1	4	1	H5216_205_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	205	0	1	4	1	H5216_205_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	205	0	1	4	1	H5216_205_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	205	0	1	4	1	H5216_205_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	205	0	1	4	1	H5216_205_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	206	0	1	4	1	H5216_206_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	206	0	1	4	1	H5216_206_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	206	0	1	4	1	H5216_206_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	206	0	1	4	1	H5216_206_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	206	0	1	4	1	H5216_206_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	207	0	1	4	1	H5216_207_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	207	0	1	4	1	H5216_207_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	207	0	1	4	1	H5216_207_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	207	0	1	4	1	H5216_207_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	207	0	1	4	1	H5216_207_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	208	0	1	4	1	H5216_208_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	208	0	1	4	1	H5216_208_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	208	0	1	4	1	H5216_208_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	208	0	1	4	1	H5216_208_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	208	0	1	4	1	H5216_208_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	209	0	1	4	1	H5216_209_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	209	0	1	4	1	H5216_209_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	209	0	1	4	1	H5216_209_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	209	0	1	4	1	H5216_209_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	209	0	1	4	1	H5216_209_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	210	0	1	4	1	H5216_210_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	210	0	1	4	1	H5216_210_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	210	0	1	4	1	H5216_210_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	210	0	1	4	1	H5216_210_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	210	0	1	4	1	H5216_210_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	211	0	1	4	1	H5216_211_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	211	0	1	4	1	H5216_211_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	211	0	1	4	1	H5216_211_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	211	0	1	4	1	H5216_211_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	211	0	1	4	1	H5216_211_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	212	0	1	4	1	H5216_212_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	212	0	1	4	1	H5216_212_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	212	0	1	4	1	H5216_212_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	212	0	1	4	1	H5216_212_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	212	0	1	4	1	H5216_212_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	1	1	4	1	H5216_214_1	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	1	1	4	1	H5216_214_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	1	1	4	1	H5216_214_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	1	1	4	1	H5216_214_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	1	1	4	1	H5216_214_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	2	1	4	1	H5216_214_2	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	2	1	4	1	H5216_214_2	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	2	1	4	1	H5216_214_2	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	2	1	4	1	H5216_214_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	2	1	4	1	H5216_214_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	3	1	4	1	H5216_214_3	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	3	1	4	1	H5216_214_3	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	3	1	4	1	H5216_214_3	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	3	1	4	1	H5216_214_3	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	214	3	1	4	1	H5216_214_3	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	215	0	1	4	1	H5216_215_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	215	0	1	4	1	H5216_215_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	215	0	1	4	1	H5216_215_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	215	0	1	4	1	H5216_215_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	215	0	1	4	1	H5216_215_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	219	0	1	4	1	H5216_219_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	219	0	1	4	1	H5216_219_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	219	0	1	4	1	H5216_219_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	219	0	1	4	1	H5216_219_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	219	0	1	4	1	H5216_219_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	220	0	1	4	1	H5216_220_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	220	0	1	4	1	H5216_220_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	220	0	1	4	1	H5216_220_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	220	0	1	4	1	H5216_220_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	220	0	1	4	1	H5216_220_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	222	0	1	4	1	H5216_222_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	222	0	1	4	1	H5216_222_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	222	0	1	4	1	H5216_222_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	222	0	1	4	1	H5216_222_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5216	222	0	1	4	1	H5216_222_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5232	1	0	1	4	1	H5232_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5232	1	0	1	4	1	H5232_001_0	6	Preferred Generic	4	11	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5232	1	0	1	4	1	H5232_001_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5232	1	0	1	4	1	H5232_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5232	1	0	1	4	1	H5232_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5232	1	0	1	4	1	H5232_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				927.98	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	4	0	1	2	1	H5253_004_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	4	0	1	2	1	H5253_004_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	4	0	1	2	1	H5253_004_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	4	0	1	2	1	H5253_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	4	0	1	2	1	H5253_004_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				975	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	11	0	1	2	1	H5253_011_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	11	0	1	2	1	H5253_011_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	11	0	1	2	1	H5253_011_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	11	0	1	2	1	H5253_011_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	11	0	1	2	1	H5253_011_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				959	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	30	0	1	2	1	H5253_030_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	30	0	1	2	1	H5253_030_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	30	0	1	2	1	H5253_030_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	30	0	1	2	1	H5253_030_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	30	0	1	2	1	H5253_030_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1227	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	33	0	1	2	1	H5253_033_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	33	0	1	2	1	H5253_033_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	33	0	1	2	1	H5253_033_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	33	0	1	2	1	H5253_033_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	33	0	1	2	1	H5253_033_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				964	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	34	0	1	2	1	H5253_034_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	34	0	1	2	1	H5253_034_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	34	0	1	2	1	H5253_034_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	34	0	1	2	1	H5253_034_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	34	0	1	2	1	H5253_034_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				862	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	35	0	1	2	1	H5253_035_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	35	0	1	2	1	H5253_035_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	35	0	1	2	1	H5253_035_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	35	0	1	2	1	H5253_035_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	35	0	1	2	1	H5253_035_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				960	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	36	0	1	1	1	H5253_036_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	36	0	1	1	1	H5253_036_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	36	0	1	1	1	H5253_036_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	36	0	1	1	1	H5253_036_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	36	0	1	1	1	H5253_036_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				859	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	37	0	1	2	1	H5253_037_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	37	0	1	2	1	H5253_037_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	37	0	1	2	1	H5253_037_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	37	0	1	2	1	H5253_037_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5253	37	0	1	2	1	H5253_037_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	37	0	1	2	1	H5253_037_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	37	0	1	2	1	H5253_037_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1010	32		32																										32						32			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	38	0	1	2	1	H5253_038_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	38	0	1	2	1	H5253_038_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	38	0	1	2	1	H5253_038_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	38	0	1	2	1	H5253_038_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	38	0	1	2	1	H5253_038_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1022	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	39	0	1	2	1	H5253_039_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	39	0	1	2	1	H5253_039_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	39	0	1	2	1	H5253_039_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	39	0	1	2	1	H5253_039_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	39	0	1	2	1	H5253_039_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				848	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	43	0	1	2	1	H5253_043_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	43	0	1	2	1	H5253_043_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	43	0	1	2	1	H5253_043_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	43	0	1	2	1	H5253_043_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	43	0	1	2	1	H5253_043_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				756	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	47	0	1	1	1	H5253_047_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	47	0	1	1	1	H5253_047_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	47	0	1	1	1	H5253_047_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	47	0	1	1	1	H5253_047_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	47	0	1	1	1	H5253_047_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				854	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	48	0	1	1	1	H5253_048_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	48	0	1	1	1	H5253_048_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	48	0	1	1	1	H5253_048_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	48	0	1	1	1	H5253_048_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	48	0	1	1	1	H5253_048_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1038	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	49	0	1	1	1	H5253_049_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	49	0	1	1	1	H5253_049_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	49	0	1	1	1	H5253_049_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	49	0	1	1	1	H5253_049_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	49	0	1	1	1	H5253_049_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1082	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	50	0	1	1	1	H5253_050_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	50	0	1	1	1	H5253_050_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	50	0	1	1	1	H5253_050_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	50	0	1	1	1	H5253_050_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	50	0	1	1	1	H5253_050_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	50	0	1	1	1	H5253_050_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	50	0	1	1	1	H5253_050_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				886	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	51	0	1	1	1	H5253_051_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	51	0	1	1	1	H5253_051_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	51	0	1	1	1	H5253_051_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	51	0	1	1	1	H5253_051_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	51	0	1	1	1	H5253_051_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	51	0	1	1	1	H5253_051_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	51	0	1	1	1	H5253_051_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1259	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	52	0	1	1	1	H5253_052_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	52	0	1	1	1	H5253_052_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	52	0	1	1	1	H5253_052_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	52	0	1	1	1	H5253_052_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	52	0	1	1	1	H5253_052_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				842	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	54	0	1	1	1	H5253_054_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	54	0	1	1	1	H5253_054_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	54	0	1	1	1	H5253_054_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	54	0	1	1	1	H5253_054_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	54	0	1	1	1	H5253_054_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	54	0	1	1	1	H5253_054_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	54	0	1	1	1	H5253_054_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1727	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	61	0	1	2	1	H5253_061_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	61	0	1	2	1	H5253_061_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	61	0	1	2	1	H5253_061_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	61	0	1	2	1	H5253_061_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	61	0	1	2	1	H5253_061_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				725	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	62	0	1	1	1	H5253_062_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	62	0	1	1	1	H5253_062_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	62	0	1	1	1	H5253_062_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	62	0	1	1	1	H5253_062_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	62	0	1	1	1	H5253_062_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				682	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	63	0	1	1	1	H5253_063_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	63	0	1	1	1	H5253_063_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	63	0	1	1	1	H5253_063_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	63	0	1	1	1	H5253_063_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	63	0	1	1	1	H5253_063_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	63	0	1	1	1	H5253_063_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	63	0	1	1	1	H5253_063_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				942	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	64	0	1	2	1	H5253_064_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	64	0	1	2	1	H5253_064_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	64	0	1	2	1	H5253_064_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	64	0	1	2	1	H5253_064_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	64	0	1	2	1	H5253_064_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1315	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	67	0	1	1	1	H5253_067_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	67	0	1	1	1	H5253_067_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	67	0	1	1	1	H5253_067_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	67	0	1	1	1	H5253_067_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	67	0	1	1	1	H5253_067_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	67	0	1	1	1	H5253_067_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	67	0	1	1	1	H5253_067_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				653	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	72	0	1	2	1	H5253_072_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	72	0	1	2	1	H5253_072_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	72	0	1	2	1	H5253_072_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	72	0	1	2	1	H5253_072_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	72	0	1	2	1	H5253_072_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				792	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	73	0	1	2	1	H5253_073_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	73	0	1	2	1	H5253_073_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	73	0	1	2	1	H5253_073_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	73	0	1	2	1	H5253_073_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	73	0	1	2	1	H5253_073_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				848	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	77	0	1	2	1	H5253_077_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	77	0	1	2	1	H5253_077_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	77	0	1	2	1	H5253_077_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	77	0	1	2	1	H5253_077_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	77	0	1	2	1	H5253_077_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1286	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	79	0	1	2	1	H5253_079_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	79	0	1	2	1	H5253_079_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	79	0	1	2	1	H5253_079_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	79	0	1	2	1	H5253_079_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	79	0	1	2	1	H5253_079_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				861	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	80	0	1	2	1	H5253_080_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	80	0	1	2	1	H5253_080_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	80	0	1	2	1	H5253_080_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	80	0	1	2	1	H5253_080_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	80	0	1	2	1	H5253_080_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	80	0	1	2	1	H5253_080_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				797	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	81	0	1	1	1	H5253_081_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	81	0	1	1	1	H5253_081_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	81	0	1	1	1	H5253_081_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	81	0	1	1	1	H5253_081_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	81	0	1	1	1	H5253_081_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				926	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	82	0	1	1	1	H5253_082_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	82	0	1	1	1	H5253_082_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	82	0	1	1	1	H5253_082_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	82	0	1	1	1	H5253_082_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	82	0	1	1	1	H5253_082_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1033	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	83	0	1	1	1	H5253_083_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	83	0	1	1	1	H5253_083_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	83	0	1	1	1	H5253_083_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	83	0	1	1	1	H5253_083_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	83	0	1	1	1	H5253_083_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				785	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	84	0	1	1	1	H5253_084_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	84	0	1	1	1	H5253_084_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	84	0	1	1	1	H5253_084_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	84	0	1	1	1	H5253_084_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	84	0	1	1	1	H5253_084_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				803	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	87	0	1	1	1	H5253_087_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	87	0	1	1	1	H5253_087_0	2	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	87	0	1	1	1	H5253_087_0	2	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	87	0	1	1	1	H5253_087_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	87	0	1	1	1	H5253_087_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	87	0	1	1	1	H5253_087_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				752	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	88	0	1	1	1	H5253_088_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	88	0	1	1	1	H5253_088_0	2	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	88	0	1	1	1	H5253_088_0	2	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	88	0	1	1	1	H5253_088_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	88	0	1	1	1	H5253_088_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	88	0	1	1	1	H5253_088_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				964	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	89	0	1	1	1	H5253_089_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	89	0	1	1	1	H5253_089_0	2	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	89	0	1	1	1	H5253_089_0	2	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	89	0	1	1	1	H5253_089_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	89	0	1	1	1	H5253_089_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	89	0	1	1	1	H5253_089_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				796	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	90	0	1	1	1	H5253_090_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	90	0	1	1	1	H5253_090_0	2	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	90	0	1	1	1	H5253_090_0	2	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	90	0	1	1	1	H5253_090_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	90	0	1	1	1	H5253_090_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	90	0	1	1	1	H5253_090_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1208	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	91	0	1	1	1	H5253_091_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	91	0	1	1	1	H5253_091_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	91	0	1	1	1	H5253_091_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	91	0	1	1	1	H5253_091_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	91	0	1	1	1	H5253_091_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				748	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	97	0	1	1	1	H5253_097_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	97	0	1	1	1	H5253_097_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	97	0	1	1	1	H5253_097_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	97	0	1	1	1	H5253_097_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	97	0	1	1	1	H5253_097_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				796	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	99	0	1	1	1	H5253_099_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	99	0	1	1	1	H5253_099_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	99	0	1	1	1	H5253_099_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	99	0	1	1	1	H5253_099_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	99	0	1	1	1	H5253_099_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				808	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	100	0	1	1	1	H5253_100_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	100	0	1	1	1	H5253_100_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	100	0	1	1	1	H5253_100_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	100	0	1	1	1	H5253_100_0	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	100	0	1	1	1	H5253_100_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	100	0	1	1	1	H5253_100_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	100	0	1	1	1	H5253_100_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				711	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	102	0	1	2	1	H5253_102_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	102	0	1	2	1	H5253_102_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	102	0	1	2	1	H5253_102_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	102	0	1	2	1	H5253_102_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	102	0	1	2	1	H5253_102_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	102	0	1	2	1	H5253_102_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				903	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	103	0	1	1	1	H5253_103_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	103	0	1	1	1	H5253_103_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	103	0	1	1	1	H5253_103_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	103	0	1	1	1	H5253_103_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	103	0	1	1	1	H5253_103_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1019	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	104	0	1	2	1	H5253_104_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	104	0	1	2	1	H5253_104_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	104	0	1	2	1	H5253_104_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	104	0	1	2	1	H5253_104_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	104	0	1	2	1	H5253_104_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	104	0	1	2	1	H5253_104_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				979	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	105	0	1	1	1	H5253_105_0	7	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	105	0	1	1	1	H5253_105_0	7	Generic	4	1	3	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	105	0	1	1	1	H5253_105_0	7	Generic	4	1	3	2	2	3		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	105	0	1	1	1	H5253_105_0	7	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	105	0	1	1	1	H5253_105_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	105	0	1	1	1	H5253_105_0	7	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											714	25		25				643	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	1	1	2	1	H5253_106_1	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	1	1	2	1	H5253_106_1	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	1	1	2	1	H5253_106_1	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	1	1	2	1	H5253_106_1	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	1	1	2	1	H5253_106_1	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				956	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	2	1	2	1	H5253_106_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	2	1	2	1	H5253_106_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	2	1	2	1	H5253_106_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	2	1	2	1	H5253_106_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	106	2	1	2	1	H5253_106_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				956	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	1	1	2	1	H5253_107_1	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	1	1	2	1	H5253_107_1	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	1	1	2	1	H5253_107_1	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	1	1	2	1	H5253_107_1	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	1	1	2	1	H5253_107_1	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				827	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	2	1	2	1	H5253_107_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	2	1	2	1	H5253_107_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	2	1	2	1	H5253_107_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	2	1	2	1	H5253_107_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	107	2	1	2	1	H5253_107_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				827	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	1	1	2	1	H5253_108_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	1	1	2	1	H5253_108_1	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	1	1	2	1	H5253_108_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	1	1	2	1	H5253_108_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	1	1	2	1	H5253_108_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1069	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	2	1	2	1	H5253_108_2	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	2	1	2	1	H5253_108_2	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	2	1	2	1	H5253_108_2	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	2	1	2	1	H5253_108_2	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	108	2	1	2	1	H5253_108_2	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1069	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	1	1	1	1	H5253_109_1	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	1	1	1	1	H5253_109_1	2	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	109	1	1	1	1	H5253_109_1	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	1	1	1	1	H5253_109_1	2	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	109	1	1	1	1	H5253_109_1	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	1	1	1	1	H5253_109_1	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	1	1	1	1	H5253_109_1	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				743	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	2	1	1	1	H5253_109_2	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	2	1	1	1	H5253_109_2	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	109	2	1	1	1	H5253_109_2	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	2	1	1	1	H5253_109_2	3	Generic	4	1	1	2	2	3	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5253	109	2	1	1	1	H5253_109_2	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	2	1	1	1	H5253_109_2	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	109	2	1	1	1	H5253_109_2	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				743	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	110	0	1	1	1	H5253_110_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	110	0	1	1	1	H5253_110_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	110	0	1	1	1	H5253_110_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	110	0	1	1	1	H5253_110_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	110	0	1	1	1	H5253_110_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											831	25		25				728	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	1	1	1	1	H5253_111_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	1	1	1	1	H5253_111_1	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	13		26																											39						0				13				13		0.43						0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	1	1	1	1	H5253_111_1	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	13		26																											39						0				13				13		0.43						0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	111	1	1	1	1	H5253_111_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	1	1	1	1	H5253_111_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	1	1	1	1	H5253_111_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				830	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	2	1	1	1	H5253_111_2	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	2	1	1	1	H5253_111_2	2	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	13		26																											39						0				13				13		0.43						0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	2	1	1	1	H5253_111_2	2	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	13		26																											39						0				13				13		0.43						0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	111	2	1	1	1	H5253_111_2	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	2	1	1	1	H5253_111_2	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	111	2	1	1	1	H5253_111_2	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				830	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	1	1	1	1	H5253_112_1	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	1	1	1	1	H5253_112_1	3	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	1	1	1	1	H5253_112_1	3	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	112	1	1	1	1	H5253_112_1	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	1	1	1	1	H5253_112_1	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	1	1	1	1	H5253_112_1	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1027	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	2	1	1	1	H5253_112_2	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	2	1	1	1	H5253_112_2	2	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	2	1	1	1	H5253_112_2	2	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
H5253	112	2	1	1	1	H5253_112_2	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	2	1	1	1	H5253_112_2	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5253	112	2	1	1	1	H5253_112_2	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1027	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	1	0	1	1	1	H5262_001_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	1	0	1	1	1	H5262_001_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	1	0	1	1	1	H5262_001_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					113																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	1	0	1	1	1	H5262_001_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				61.55	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	1	0	1	1	1	H5262_001_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	3	0	1	1	1	H5262_003_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	3	0	1	1	1	H5262_003_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	3	0	1	1	1	H5262_003_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					113																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	3	0	1	1	1	H5262_003_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				81.47	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	3	0	1	1	1	H5262_003_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	7	0	1	1	1	H5262_007_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	6	12	18																					15																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	7	0	1	1	1	H5262_007_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	7	0	1	1	1	H5262_007_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					118																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	7	0	1	1	1	H5262_007_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				74.5	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	7	0	1	1	1	H5262_007_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	8	0	1	1	1	H5262_008_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	6	12	18																					15																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	8	0	1	1	1	H5262_008_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	8	0	1	1	1	H5262_008_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					118																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	8	0	1	1	1	H5262_008_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				95.12	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	8	0	1	1	1	H5262_008_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	11	0	1	1	1	H5262_011_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					4																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	11	0	1	1	1	H5262_011_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					12																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	11	0	1	1	1	H5262_011_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					118																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	11	0	1	1	1	H5262_011_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				73.57	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	11	0	1	1	1	H5262_011_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	12	0	1	1	1	H5262_012_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					4																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	12	0	1	1	1	H5262_012_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					12																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	12	0	1	1	1	H5262_012_0	3	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					118																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	12	0	1	1	1	H5262_012_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				99.45	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	12	0	1	1	1	H5262_012_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	18	0	1	1	1	H5262_018_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	18	0	1	1	1	H5262_018_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					30																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	18	0	1	1	1	H5262_018_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					118																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	18	0	1	1	1	H5262_018_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				63.02	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	18	0	1	1	1	H5262_018_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	19	0	1	1	1	H5262_019_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	19	0	1	1	1	H5262_019_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	36																					30																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	19	0	1	1	1	H5262_019_0	3	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					118																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	19	0	1	1	1	H5262_019_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				81.2	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	19	0	1	1	1	H5262_019_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	21	0	1	1	1	H5262_021_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	21	0	1	1	1	H5262_021_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	21	0	1	1	1	H5262_021_0	3	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					113																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	21	0	1	1	1	H5262_021_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				81.2	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	21	0	1	1	1	H5262_021_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	23	0	1	1	1	H5262_023_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	6	12	18																					15																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	23	0	1	1	1	H5262_023_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	23	0	1	1	1	H5262_023_0	3	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					118																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	23	0	1	1	1	H5262_023_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				81.22	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5262	23	0	1	1	1	H5262_023_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5273	1	0	1	1	1	H5273_001_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				0			0.33	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	1	0	1	1	1	H5273_001_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	20																15				10			0.5	0.33	0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	1	0	1	1	1	H5273_001_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	1	0	1	1	1	H5273_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	1	0	1	1	1	H5273_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	1	0	1	1	1	H5273_001_0	6	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	2	0	1	1	1	H5273_002_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				0			0.33	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	2	0	1	1	1	H5273_002_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	20																15				10			0.5	0.33	0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	2	0	1	1	1	H5273_002_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	2	0	1	1	1	H5273_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	2	0	1	1	1	H5273_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	2	0	1	1	1	H5273_002_0	5	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	3	0	1	1	1	H5273_003_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				0			0.33	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	3	0	1	1	1	H5273_003_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					10	20	30					10	20	20																15				10			0.5	0.33	0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	3	0	1	1	1	H5273_003_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	3	0	1	1	1	H5273_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	3	0	1	1	1	H5273_003_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5273	3	0	1	1	1	H5273_003_0	5	Vaccines	4	11	1	2	6	1		10	1			1				30											30		31								0							0																									0				0			0	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H5280	1	0	1	48	5	H5280_001_0	8	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H5280	1	0	1	48	5	H5280_001_0	8	Brand Drugs	4	11			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H5280	1	0	1	48	5	H5280_001_0	8	Non-Medicare Rx/OTC Drugs	4	11			3	1	10		1	10		1	31								31						31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H5294	2	2	1	1	1	H5294_002_2	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	2	1	1	1	H5294_002_2	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	19	38	57																			19	38	57																19				19		0.63			0.63			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	2	1	1	1	H5294_002_2	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	2	1	1	1	H5294_002_2	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	2	1	1	1	H5294_002_2	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	2	1	1	1	H5294_002_2	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	3	1	1	1	H5294_002_3	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	3	1	1	1	H5294_002_3	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	19	38	57																			19	38	57																19				19		0.63			0.63			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	3	1	1	1	H5294_002_3	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	3	1	1	1	H5294_002_3	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	3	1	1	1	H5294_002_3	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	3	1	1	1	H5294_002_3	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	4	1	1	1	H5294_002_4	3	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	4	1	1	1	H5294_002_4	3	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	19	38	57																			19	38	57																19				19		0.63			0.63			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	4	1	1	1	H5294_002_4	3	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	4	1	1	1	H5294_002_4	3	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	4	1	1	1	H5294_002_4	3	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	2	4	1	1	1	H5294_002_4	3	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	7	0	1	1	1	H5294_007_0	3	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	7	0	1	1	1	H5294_007_0	3	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	19	38	57																			19	38	57																19				19		0.63			0.63			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	7	0	1	1	1	H5294_007_0	3	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	7	0	1	1	1	H5294_007_0	3	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	7	0	1	1	1	H5294_007_0	3	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	7	0	1	1	1	H5294_007_0	3	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	9	0	1	1	1	H5294_009_0	3	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	9	0	1	1	1	H5294_009_0	3	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	19	38	57																			19	38	57																19				19		0.63			0.63			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	9	0	1	1	1	H5294_009_0	3	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	9	0	1	1	1	H5294_009_0	3	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	9	0	1	1	1	H5294_009_0	3	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5294	9	0	1	1	1	H5294_009_0	3	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5302	11	0	1	1	1	H5302_011_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	11	0	1	1	1	H5302_011_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5302	11	0	1	1	1	H5302_011_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	11	0	1	1	1	H5302_011_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5302	11	0	1	1	1	H5302_011_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	11	0	1	1	1	H5302_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	11	0	1	1	1	H5302_011_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											652.4	30						608.74	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	12	0	1	1	1	H5302_012_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	12	0	1	1	1	H5302_012_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	12	0	1	1	1	H5302_012_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	12	0	1	1	1	H5302_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	12	0	1	1	1	H5302_012_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				599.67	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	13	0	1	1	1	H5302_013_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	13	0	1	1	1	H5302_013_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	13	0	1	1	1	H5302_013_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	13	0	1	1	1	H5302_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5302	13	0	1	1	1	H5302_013_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				599.67	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5322	24	0	1	1	1	H5322_024_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	24	0	1	1	1	H5322_024_0	6	Generic	4	11	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	15		45																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	24	0	1	1	1	H5322_024_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	24	0	1	1	1	H5322_024_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	24	0	1	1	1	H5322_024_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				705	26		26																										26						26			26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	26	0	1	1	1	H5322_026_0	3	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	26	0	1	1	1	H5322_026_0	3	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	26	0	1	1	1	H5322_026_0	3	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	26	0	1	1	1	H5322_026_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5322	26	0	1	1	1	H5322_026_0	3	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5325	1	0	1	1	1	H5325_001_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	1	0	1	1	1	H5325_001_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	1	0	1	1	1	H5325_001_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	1	0	1	1	1	H5325_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	1	0	1	1	1	H5325_001_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				623.15	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	2	0	1	1	1	H5325_002_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	2	0	1	1	1	H5325_002_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	2	0	1	1	1	H5325_002_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	2	0	1	1	1	H5325_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	2	0	1	1	1	H5325_002_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				623.15	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	3	0	1	1	1	H5325_003_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	3	0	1	1	1	H5325_003_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	3	0	1	1	1	H5325_003_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	3	0	1	1	1	H5325_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	3	0	1	1	1	H5325_003_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				602	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	4	0	1	1	1	H5325_004_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	4	0	1	1	1	H5325_004_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	4	0	1	1	1	H5325_004_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	4	0	1	1	1	H5325_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	4	0	1	1	1	H5325_004_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				602	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	5	0	1	1	1	H5325_005_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	5	0	1	1	1	H5325_005_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	5	0	1	1	1	H5325_005_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	5	0	1	1	1	H5325_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5325	5	0	1	1	1	H5325_005_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				602	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5337	1	0	1	1	1	H5337_001_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5337	1	0	1	1	1	H5337_001_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5337	1	0	1	1	1	H5337_001_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5337	1	0	1	1	1	H5337_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5337	1	0	1	1	1	H5337_001_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				608.61	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5355	1	0	1	48	5	H5355_001_0	2	Generic Drugs	4	1			1	1	110		1	110		1	31		90				2	2	31		90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H5355	1	0	1	48	5	H5355_001_0	2	Brand Drugs	4	10			2	1	110		1	110		1	31		90				2	2	31		90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H5355	1	0	1	48	5	H5355_001_0	2	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		1	110		1	31		90				1	2	31		90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H5377	1	0	1	1	1	H5377_001_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5377	1	0	1	1	1	H5377_001_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5377	1	0	1	1	1	H5377_001_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5377	1	0	1	1	1	H5377_001_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5377	1	0	1	1	1	H5377_001_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5386	3	0	1	1	1	H5386_003_0	5	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		34	4	8	12																					0																4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	3	0	1	1	1	H5386_003_0	5	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		34	8	16	24																					0																8				8		0.27						0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	3	0	1	1	1	H5386_003_0	5	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		34	47	94	141																					94																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	3	0	1	1	1	H5386_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		34	100	200	300																					200																100				100		3.33						2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	3	0	1	1	1	H5386_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34				762.79	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	3	0	1	1	1	H5386_003_0	5	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		34	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	4	0	1	1	1	H5386_004_0	5	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		34	4	8	12																					0																4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	4	0	1	1	1	H5386_004_0	5	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		34	8	16	24																					0																8				8		0.27						0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	4	0	1	1	1	H5386_004_0	5	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		34	47	94	141																					94																47				47		1.57						1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	4	0	1	1	1	H5386_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		34	100	200	300																					200																100				100		3.33						2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	4	0	1	1	1	H5386_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34				712.67	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5386	4	0	1	1	1	H5386_004_0	5	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		34	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	1	0	1	1	1	H5398_001_0	4	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	4																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	1	0	1	1	1	H5398_001_0	4	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	1	0	1	1	1	H5398_001_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	1	0	1	1	1	H5398_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	1	0	1	1	1	H5398_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					26																																					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	1	0	1	1	1	H5398_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	2	0	1	1	1	H5398_002_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	2	0	1	1	1	H5398_002_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	2	0	1	1	1	H5398_002_0	3	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	2	0	1	1	1	H5398_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	2	0	1	1	1	H5398_002_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5398	2	0	1	1	1	H5398_002_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5410	1	0	1	1	1	H5410_001_0	7	Generic	4	11	3	2	1	1		111	1			1				30	60	90	2	2							30		31								5	10	15					0	0	0																							5				5			0.17	0				0.16	"Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	1	0	1	1	1	H5410_001_0	7	Generic	4	11	3	2	1	3		111	1			1				30	60	90	2	2							30		31								5	10	15					0	0	0																							5				5			0.17	0				0.16	"Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5410	1	0	1	1	1	H5410_001_0	7	Preferred Brand	4	10	1	2	2	1		111	1			1				30	60	90	2	2							30		31								10	20	30					0	0	0																							10				10			0.33	0				0.32	"Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	1	0	1	1	1	H5410_001_0	7	Non-Preferred Drug	4	11	1	2	3	1		111	1			1				30	60	90	2	2							30		31								50	100	150					40	80	80																							50				50			1.67	1.33				1.61	"Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	1	0	1	1	1	H5410_001_0	7	Specialty Tier	4	11	1	1	4	1		10	1			1				30											30		31											1006.91	33						662.04	33																							33			33								"Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	18	0	1	1	1	H5410_018_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	18	0	1	1	1	H5410_018_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								17	34	51					12	24	24											17	34	51				12	24	0				17				17			0.57	0.4		0.57	0.4	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	18	0	1	1	1	H5410_018_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	18	0	1	1	1	H5410_018_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	18	0	1	1	1	H5410_018_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											904.65	33						1067.05	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	24	0	1	1	1	H5410_024_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	24	0	1	1	1	H5410_024_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					0	0	0											20	40	60				0	0	0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	24	0	1	1	1	H5410_024_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	24	0	1	1	1	H5410_024_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	24	0	1	1	1	H5410_024_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											894.44	33						952.34	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	26	0	1	1	1	H5410_026_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					0	0	0											7	14	21				0	0	0				7				7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	26	0	1	1	1	H5410_026_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	26	0	1	1	1	H5410_026_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	26	0	1	1	1	H5410_026_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	26	0	1	1	1	H5410_026_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											894.44	33						952.34	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	27	0	1	1	1	H5410_027_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	27	0	1	1	1	H5410_027_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					0	0	0											20	40	60				0	0	0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	27	0	1	1	1	H5410_027_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	27	0	1	1	1	H5410_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	27	0	1	1	1	H5410_027_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											894.44	33						952.34	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	28	0	1	1	1	H5410_028_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					0	0	0											7	14	21				0	0	0				7				7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	28	0	1	1	1	H5410_028_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	28	0	1	1	1	H5410_028_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	28	0	1	1	1	H5410_028_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	28	0	1	1	1	H5410_028_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											894.44	33						952.34	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	29	0	1	1	1	H5410_029_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	29	0	1	1	1	H5410_029_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					0	0	0											20	40	60				0	0	0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	29	0	1	1	1	H5410_029_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	29	0	1	1	1	H5410_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	29	0	1	1	1	H5410_029_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											894.44	33						952.34	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	30	0	1	1	1	H5410_030_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					0	0	0											7	14	21				0	0	0				7				7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	30	0	1	1	1	H5410_030_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	30	0	1	1	1	H5410_030_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	30	0	1	1	1	H5410_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5410	30	0	1	1	1	H5410_030_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											894.44	33						952.34	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	1	0	1	1	1	H5420_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	1	0	1	1	1	H5420_001_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5420	1	0	1	1	1	H5420_001_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	1	0	1	1	1	H5420_001_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5420	1	0	1	1	1	H5420_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	30		90																											90						80				30				30		1						0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	1	0	1	1	1	H5420_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	65		195																											195						185				65				65		2.16						2.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	1	0	1	1	1	H5420_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				900	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	3	0	1	1	1	H5420_003_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	3	0	1	1	1	H5420_003_0	3	Preferred Generic	4	1	1	2	1	3	110		1		100	1	30		100				2	2						100	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5420	3	0	1	1	1	H5420_003_0	3	Generic	4	1	3	2	2	1	110		1		100	1	30		100				2	2						100	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	3	0	1	1	1	H5420_003_0	3	Generic	4	1	3	2	2	3	110		1		100	1	30		100				2	2						100	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5420	3	0	1	1	1	H5420_003_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		100				2	2						100	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	3	0	1	1	1	H5420_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		100				2	2						100	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	3	0	1	1	1	H5420_003_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		100				2	2						100	30		31				904	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	6	0	1	1	1	H5420_006_0	3	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	6	0	1	1	1	H5420_006_0	3	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5420	6	0	1	1	1	H5420_006_0	3	Generic	4	1	3	2	2	1	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	6	0	1	1	1	H5420_006_0	3	Generic	4	1	3	2	2	3	110		1	100		1	30		100				2	2			100				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5420	6	0	1	1	1	H5420_006_0	3	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		100				2	2			100				30		31				45	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	6	0	1	1	1	H5420_006_0	3	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		100				2	2			100				30		31				54	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5420	6	0	1	1	1	H5420_006_0	3	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		100				2	2			100				30		31				647	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5422	7	0	1	1	1	H5422_007_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	7	0	1	1	1	H5422_007_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5422	7	0	1	1	1	H5422_007_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	12	12																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	7	0	1	1	1	H5422_007_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					42	84	126					42	126	126																42				42			1.4	1.4	1.4			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	7	0	1	1	1	H5422_007_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	7	0	1	1	1	H5422_007_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	7	0	1	1	1	H5422_007_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	7	0	1	1	1	H5422_007_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5422	8	0	1	1	1	H5422_008_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	8	0	1	1	1	H5422_008_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	8	0	1	1	1	H5422_008_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	8	0	1	1	1	H5422_008_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	8	0	1	1	1	H5422_008_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	8	0	1	1	1	H5422_008_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	8	0	1	1	1	H5422_008_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5422	11	0	1	1	1	H5422_011_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	11	0	1	1	1	H5422_011_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								16	32	48					11	22	33					11	22	22																16				16			0.53	0.37	0.37			0.47	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	11	0	1	1	1	H5422_011_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	11	0	1	1	1	H5422_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	11	0	1	1	1	H5422_011_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	11	0	1	1	1	H5422_011_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	11	0	1	1	1	H5422_011_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5422	13	0	1	1	1	H5422_013_0	6	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	13	0	1	1	1	H5422_013_0	6	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5422	13	0	1	1	1	H5422_013_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					10	20	30					10	30	30																10				10			0.33	0.33	0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	13	0	1	1	1	H5422_013_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	13	0	1	1	1	H5422_013_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	13	0	1	1	1	H5422_013_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	13	0	1	1	1	H5422_013_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5422	13	0	1	1	1	H5422_013_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5425	1	0	1	1	1	H5425_001_0	7	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					2	4	4					2	4	0																10				10			0.33	0.07	0.07			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	1	0	1	1	1	H5425_001_0	7	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					2	4	4					2	4	0																10				10			0.33	0.07	0.07			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	1	0	1	1	1	H5425_001_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					5	10	10					5	10	0																15				15			0.5	0.17	0.17			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	1	0	1	1	1	H5425_001_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	1	0	1	1	1	H5425_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	1	0	1	1	1	H5425_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	4	0	1	1	1	H5425_004_0	8	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	4	0	1	1	1	H5425_004_0	8	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	4	0	1	1	1	H5425_004_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					3	6	6					3	6	0																12				12			0.4	0.1	0.1			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	4	0	1	1	1	H5425_004_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					3	6	6					3	6	0																12				12			0.4	0.1	0.1			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	4	0	1	1	1	H5425_004_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	4	0	1	1	1	H5425_004_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	4	0	1	1	1	H5425_004_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	5	0	1	1	1	H5425_005_0	7	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	5	0	1	1	1	H5425_005_0	7	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	5	0	1	1	1	H5425_005_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					5	10	10					5	10	0																15				15			0.5	0.17	0.17			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	5	0	1	1	1	H5425_005_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	5	0	1	1	1	H5425_005_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	5	0	1	1	1	H5425_005_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	6	0	1	1	1	H5425_006_0	9	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	6	0	1	1	1	H5425_006_0	9	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	6	0	1	1	1	H5425_006_0	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					5	10	10					5	10	0																15				15			0.5	0.17	0.17			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	6	0	1	1	1	H5425_006_0	9	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					5	10	10					5	10	0																15				15			0.5	0.17	0.17			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	6	0	1	1	1	H5425_006_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	6	0	1	1	1	H5425_006_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	6	0	1	1	1	H5425_006_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	7	0	1	1	1	H5425_007_0	7	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	7	0	1	1	1	H5425_007_0	7	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	7	0	1	1	1	H5425_007_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					5	10	10					5	10	0																15				15			0.5	0.17	0.17			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	7	0	1	1	1	H5425_007_0	7	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					5	10	10					5	10	0																15				15			0.5	0.17	0.17			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	7	0	1	1	1	H5425_007_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	7	0	1	1	1	H5425_007_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	7	0	1	1	1	H5425_007_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	8	0	1	1	1	H5425_008_0	7	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	8	0	1	1	1	H5425_008_0	7	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	8	0	1	1	1	H5425_008_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					7	14	14					7	14	0																15				15			0.5	0.23	0.23			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	8	0	1	1	1	H5425_008_0	7	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					7	14	14					7	14	0																15				15			0.5	0.23	0.23			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	8	0	1	1	1	H5425_008_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	8	0	1	1	1	H5425_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	8	0	1	1	1	H5425_008_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	9	0	1	1	1	H5425_009_0	7	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	9	0	1	1	1	H5425_009_0	7	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	9	0	1	1	1	H5425_009_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					7	14	14					7	14	0																15				15			0.5	0.23	0.23			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	9	0	1	1	1	H5425_009_0	7	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					7	14	14					7	14	0																15				15			0.5	0.23	0.23			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	9	0	1	1	1	H5425_009_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	9	0	1	1	1	H5425_009_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	9	0	1	1	1	H5425_009_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	10	0	1	1	1	H5425_010_0	9	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	10	0	1	1	1	H5425_010_0	9	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	10	0	1	1	1	H5425_010_0	9	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.1	25	25	25				5.1	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	10	0	1	1	1	H5425_010_0	9	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											64.88	25	25	25				64.88	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	10	0	1	1	1	H5425_010_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											74.76	25	25	25				74.76	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	10	0	1	1	1	H5425_010_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	19	0	1	1	1	H5425_019_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					3	6	6					3	6	0																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	19	0	1	1	1	H5425_019_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					5	10	10					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	19	0	1	1	1	H5425_019_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	19	0	1	1	1	H5425_019_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	19	0	1	1	1	H5425_019_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	20	0	1	1	1	H5425_020_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					3	6	6					3	6	0																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	20	0	1	1	1	H5425_020_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					5	10	10					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	20	0	1	1	1	H5425_020_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	20	0	1	1	1	H5425_020_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	20	0	1	1	1	H5425_020_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	28	0	1	1	1	H5425_028_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	28	0	1	1	1	H5425_028_0	8	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	28	0	1	1	1	H5425_028_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					2	4	4					2	4	0																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	28	0	1	1	1	H5425_028_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					2	4	4					2	4	0																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	28	0	1	1	1	H5425_028_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	28	0	1	1	1	H5425_028_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	28	0	1	1	1	H5425_028_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	29	0	1	1	1	H5425_029_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	29	0	1	1	1	H5425_029_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	29	0	1	1	1	H5425_029_0	7	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.31	25	25	25				5.31	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	29	0	1	1	1	H5425_029_0	7	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											57.36	25	25	25				57.36	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	29	0	1	1	1	H5425_029_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											66.53	25	25	25				66.53	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	29	0	1	1	1	H5425_029_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	30	0	1	1	1	H5425_030_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	30	0	1	1	1	H5425_030_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	30	0	1	1	1	H5425_030_0	7	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.1	25	25	25				5.1	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	30	0	1	1	1	H5425_030_0	7	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											57.43	25	25	25				57.43	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	30	0	1	1	1	H5425_030_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											67.91	25	25	25				67.91	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	30	0	1	1	1	H5425_030_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	31	0	1	1	1	H5425_031_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	31	0	1	1	1	H5425_031_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	31	0	1	1	1	H5425_031_0	7	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											4.9	25	25	25				4.9	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	31	0	1	1	1	H5425_031_0	7	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											57.06	25	25	25				57.06	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	31	0	1	1	1	H5425_031_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											63.51	25	25	25				63.51	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	31	0	1	1	1	H5425_031_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	33	0	1	1	1	H5425_033_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	33	0	1	1	1	H5425_033_0	8	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	33	0	1	1	1	H5425_033_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	28					7	14	14					7	14	0																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	33	0	1	1	1	H5425_033_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	28					7	14	14					7	14	0																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	33	0	1	1	1	H5425_033_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	33	0	1	1	1	H5425_033_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	33	0	1	1	1	H5425_033_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	34	0	1	1	1	H5425_034_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	34	0	1	1	1	H5425_034_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	34	0	1	1	1	H5425_034_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					2	4	4					2	4	0																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	34	0	1	1	1	H5425_034_0	7	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	18					2	4	4					2	4	0																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	34	0	1	1	1	H5425_034_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								35	70	85					30	60	70					30	60	70																35				35			1.17	1	1			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	34	0	1	1	1	H5425_034_0	7	Preferred Brand	4	11	1	2	3	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								35	70	85					30	60	70					30	60	70																35				35			1.17	1	1			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H5425	34	0	1	1	1	H5425_034_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	34	0	1	1	1	H5425_034_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	40	0	1	1	1	H5425_040_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	40	0	1	1	1	H5425_040_0	7	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.61	25	25	25				5.61	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	40	0	1	1	1	H5425_040_0	7	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											60.6	25	25	25				60.6	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	40	0	1	1	1	H5425_040_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											69.21	25	25	25				69.21	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	40	0	1	1	1	H5425_040_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	45	0	1	1	1	H5425_045_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	45	0	1	1	1	H5425_045_0	7	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.77	25	25	25				5.77	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	45	0	1	1	1	H5425_045_0	7	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											59.8	25	25	25				59.8	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	45	0	1	1	1	H5425_045_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											77.96	25	25	25				77.96	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	45	0	1	1	1	H5425_045_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	52	0	1	1	1	H5425_052_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	52	0	1	1	1	H5425_052_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	34					10	20	20					10	20	0																17				17			0.57	0.33	0.33			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	52	0	1	1	1	H5425_052_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	52	0	1	1	1	H5425_052_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	52	0	1	1	1	H5425_052_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	53	0	1	1	1	H5425_053_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	53	0	1	1	1	H5425_053_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	53	0	1	1	1	H5425_053_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	34					10	20	20					10	20	0																17				17			0.57	0.33	0.33			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	53	0	1	1	1	H5425_053_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	53	0	1	1	1	H5425_053_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	53	0	1	1	1	H5425_053_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	54	0	1	1	1	H5425_054_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	54	0	1	1	1	H5425_054_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	54	0	1	1	1	H5425_054_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	34					10	20	20					10	20	0																17				17			0.57	0.33	0.33			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	54	0	1	1	1	H5425_054_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	54	0	1	1	1	H5425_054_0	7	Preferred Brand	4	11	1	2	3	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H5425	54	0	1	1	1	H5425_054_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	54	0	1	1	1	H5425_054_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	55	0	1	1	1	H5425_055_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	55	0	1	1	1	H5425_055_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	55	0	1	1	1	H5425_055_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					5	10	10					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	55	0	1	1	1	H5425_055_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	55	0	1	1	1	H5425_055_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	55	0	1	1	1	H5425_055_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	64	0	1	1	1	H5425_064_0	7	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	64	0	1	1	1	H5425_064_0	7	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	64	0	1	1	1	H5425_064_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					7	14	14					7	14	0																15				15			0.5	0.23	0.23			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	64	0	1	1	1	H5425_064_0	7	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					7	14	14					7	14	0																15				15			0.5	0.23	0.23			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	64	0	1	1	1	H5425_064_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	64	0	1	1	1	H5425_064_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	64	0	1	1	1	H5425_064_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	65	0	1	1	1	H5425_065_0	8	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	65	0	1	1	1	H5425_065_0	8	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	65	0	1	1	1	H5425_065_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					5	10	10					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	65	0	1	1	1	H5425_065_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					5	10	10					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	65	0	1	1	1	H5425_065_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	65	0	1	1	1	H5425_065_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	65	0	1	1	1	H5425_065_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	66	0	1	1	1	H5425_066_0	8	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	66	0	1	1	1	H5425_066_0	8	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	66	0	1	1	1	H5425_066_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					5	10	10					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	66	0	1	1	1	H5425_066_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	24					5	10	10					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	66	0	1	1	1	H5425_066_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	66	0	1	1	1	H5425_066_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	66	0	1	1	1	H5425_066_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	67	0	1	1	1	H5425_067_0	8	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	67	0	1	1	1	H5425_067_0	8	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	67	0	1	1	1	H5425_067_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	28					7	14	14					7	14	0																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	67	0	1	1	1	H5425_067_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	28					7	14	14					7	14	0																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	67	0	1	1	1	H5425_067_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	67	0	1	1	1	H5425_067_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	67	0	1	1	1	H5425_067_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	68	0	1	1	1	H5425_068_0	9	Preferred Generic	4	11	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	68	0	1	1	1	H5425_068_0	9	Preferred Generic	4	11	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	14					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5425	68	0	1	1	1	H5425_068_0	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	28					7	14	14					7	14	0																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	68	0	1	1	1	H5425_068_0	9	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	28					7	14	14					7	14	0																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	68	0	1	1	1	H5425_068_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	68	0	1	1	1	H5425_068_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	68	0	1	1	1	H5425_068_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	69	0	1	1	1	H5425_069_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	69	0	1	1	1	H5425_069_0	8	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	69	0	1	1	1	H5425_069_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					9	18	18					9	18	0																15				15			0.5	0.3	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	69	0	1	1	1	H5425_069_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					9	18	18					9	18	0																15				15			0.5	0.3	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	69	0	1	1	1	H5425_069_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	69	0	1	1	1	H5425_069_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					90	180	250					90	180	250																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	69	0	1	1	1	H5425_069_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	70	0	1	1	1	H5425_070_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	70	0	1	1	1	H5425_070_0	8	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	70	0	1	1	1	H5425_070_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					9	18	18					9	18	0																15				15			0.5	0.3	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	70	0	1	1	1	H5425_070_0	8	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	30					9	18	18					9	18	0																15				15			0.5	0.3	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5425	70	0	1	1	1	H5425_070_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	115					30	60	70					30	60	70																45				45			1.5	1	1			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	70	0	1	1	1	H5425_070_0	8	Preferred Brand	4	11	1	2	3	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	115					30	60	70					30	60	70																45				45			1.5	1	1			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H5425	70	0	1	1	1	H5425_070_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	265					85	170	235					85	170	235																95				95			3.17	2.83	2.83			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	70	0	1	1	1	H5425_070_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	71	0	1	1	1	H5425_071_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	27					0	0	0					0	0	0																9				9			0.3	0	0			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	71	0	1	1	1	H5425_071_0	8	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.77	25	25	25				5.77	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	71	0	1	1	1	H5425_071_0	8	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											60.01	25	25	25				60.01	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	71	0	1	1	1	H5425_071_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											70.89	25	25	25				70.89	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	71	0	1	1	1	H5425_071_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	72	0	1	1	1	H5425_072_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					0	0	0																7				7			0.23	0	0			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	72	0	1	1	1	H5425_072_0	8	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.77	25	25	25				5.77	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	72	0	1	1	1	H5425_072_0	8	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											60.02	25	25	25				60.02	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	72	0	1	1	1	H5425_072_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											70.88	25	25	25				70.88	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	72	0	1	1	1	H5425_072_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	73	0	1	1	1	H5425_073_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					5	10	10					5	10	0																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	73	0	1	1	1	H5425_073_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17.5	35	35					12.5	25	25					12.5	25	0																17.5				17.5			0.58	0.42	0.42			0.56	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	73	0	1	1	1	H5425_073_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	115					40	80	100					40	80	100																45				45			1.5	1.33	1.33			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	73	0	1	1	1	H5425_073_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	265					90	180	250					90	180	250																95				95			3.17	3	3			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	73	0	1	1	1	H5425_073_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	74	0	1	1	1	H5425_074_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					5	10	10					5	10	0																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	74	0	1	1	1	H5425_074_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	40					15	30	30					15	30	0																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	74	0	1	1	1	H5425_074_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	121					42	84	106					42	84	106																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	74	0	1	1	1	H5425_074_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	280					95	190	265					95	190	265																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5425	74	0	1	1	1	H5425_074_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	59	0	1	1	1	H5427_059_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	59	0	1	1	1	H5427_059_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	59	0	1	1	1	H5427_059_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	59	0	1	1	1	H5427_059_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	59	0	1	1	1	H5427_059_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	60	0	1	1	1	H5427_060_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	60	0	1	1	1	H5427_060_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	60	0	1	1	1	H5427_060_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	60	0	1	1	1	H5427_060_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	60	0	1	1	1	H5427_060_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	70	0	1	1	1	H5427_070_0	10	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	70	0	1	1	1	H5427_070_0	10	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H5427	70	0	1	1	1	H5427_070_0	10	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	20		60																			20		40																20				20		0.67			0.67			0.59	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	70	0	1	1	1	H5427_070_0	10	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	60		180																			60		120																60				60		2			2			1.76	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	70	0	1	1	1	H5427_070_0	10	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	70	0	1	1	1	H5427_070_0	10	Select Diabetic Drugs	4	10	1	2	5	1	110		1	110		1	30		90				1	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	70	0	1	1	1	H5427_070_0	10	Select Diabetic Drugs	4	10	1	2	5	3	110		1	110		1	30		90				1	2	30		90				30		34	10		30																			10		20																10				10		0.33			0.33			0.29	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H5427	72	0	1	1	1	H5427_072_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	72	0	1	1	1	H5427_072_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H5427	72	0	1	1	1	H5427_072_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	72	0	1	1	1	H5427_072_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	80		240																			80		160																80				80		2.67			2.67			2.35	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	72	0	1	1	1	H5427_072_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	72	0	1	1	1	H5427_072_0	9	Select Diabetic Drugs	4	10	1	2	5	1	110		1	110		1	30		90				1	2	30		90				30		34	10		30																			10		20																10				10		0.33			0.33			0.29	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	77	0	1	1	1	H5427_077_0	10	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	77	0	1	1	1	H5427_077_0	10	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	77	0	1	1	1	H5427_077_0	10	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	20		60																			20		40																20				20		0.67			0.67			0.59	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	77	0	1	1	1	H5427_077_0	10	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	60		180																			60		120																60				60		2			2			1.76	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	77	0	1	1	1	H5427_077_0	10	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	78	0	1	1	1	H5427_078_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	78	0	1	1	1	H5427_078_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	45		135																			45		135																45				45		1.5			1.5			1.32	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	78	0	1	1	1	H5427_078_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	95		285																			95		285																95				95		3.17			3.17			2.79	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	78	0	1	1	1	H5427_078_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	82	0	1	1	1	H5427_082_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	82	0	1	1	1	H5427_082_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H5427	82	0	1	1	1	H5427_082_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	82	0	1	1	1	H5427_082_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	82	0	1	1	1	H5427_082_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	82	0	1	1	1	H5427_082_0	9	Select Diabetic Drugs	4	10	1	2	5	1	110		1	110		1	30		90				1	2	30		90				30		34	10		30																			10		20																10				10		0.33			0.33			0.29	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	83	0	1	1	1	H5427_083_0	10	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	83	0	1	1	1	H5427_083_0	10	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	83	0	1	1	1	H5427_083_0	10	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	83	0	1	1	1	H5427_083_0	10	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	80		240																			80		160																80				80		2.67			2.67			2.35	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	83	0	1	1	1	H5427_083_0	10	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	87	0	1	1	1	H5427_087_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	87	0	1	1	1	H5427_087_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	45		135																			45		135																45				45		1.5			1.5			1.32	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	87	0	1	1	1	H5427_087_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	95		285																			95		285																95				95		3.17			3.17			2.79	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	87	0	1	1	1	H5427_087_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	88	0	1	1	1	H5427_088_0	10	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	88	0	1	1	1	H5427_088_0	10	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	88	0	1	1	1	H5427_088_0	10	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	88	0	1	1	1	H5427_088_0	10	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	88	0	1	1	1	H5427_088_0	10	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	89	0	1	1	1	H5427_089_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	89	0	1	1	1	H5427_089_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	89	0	1	1	1	H5427_089_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	89	0	1	1	1	H5427_089_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	70		210																			70		140																70				70		2.33			2.33			2.06	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	89	0	1	1	1	H5427_089_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	91	0	1	1	1	H5427_091_0	10	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	91	0	1	1	1	H5427_091_0	10	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	91	0	1	1	1	H5427_091_0	10	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	91	0	1	1	1	H5427_091_0	10	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	70		210																			70		140																70				70		2.33			2.33			2.06	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	91	0	1	1	1	H5427_091_0	10	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	92	0	1	1	1	H5427_092_0	10	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	92	0	1	1	1	H5427_092_0	10	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	92	0	1	1	1	H5427_092_0	10	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	92	0	1	1	1	H5427_092_0	10	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	70		210																			70		140																70				70		2.33			2.33			2.06	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	92	0	1	1	1	H5427_092_0	10	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	93	0	1	1	1	H5427_093_0	10	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	93	0	1	1	1	H5427_093_0	10	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	93	0	1	1	1	H5427_093_0	10	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	93	0	1	1	1	H5427_093_0	10	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	70		210																			70		140																70				70		2.33			2.33			2.06	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	93	0	1	1	1	H5427_093_0	10	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	94	0	1	1	1	H5427_094_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	94	0	1	1	1	H5427_094_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	94	0	1	1	1	H5427_094_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	94	0	1	1	1	H5427_094_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	70		210																			70		140																70				70		2.33			2.33			2.06	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	94	0	1	1	1	H5427_094_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	96	0	1	1	1	H5427_096_0	11	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	96	0	1	1	1	H5427_096_0	11	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	96	0	1	1	1	H5427_096_0	11	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	96	0	1	1	1	H5427_096_0	11	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	98	0	1	1	1	H5427_098_0	11	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	98	0	1	1	1	H5427_098_0	11	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5427	98	0	1	1	1	H5427_098_0	11	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	98	0	1	1	1	H5427_098_0	11	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	98	0	1	1	1	H5427_098_0	11	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5427	99	0	1	1	1	H5427_099_0	11	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	99	0	1	1	1	H5427_099_0	11	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H5427	99	0	1	1	1	H5427_099_0	11	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	40		120																			40		80																40				40		1.33			1.33			1.18	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	99	0	1	1	1	H5427_099_0	11	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	90		270																			90		180																90				90		3			3			2.65	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	99	0	1	1	1	H5427_099_0	11	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5427	99	0	1	1	1	H5427_099_0	11	Select Diabetic Drugs	4	10	1	2	5	1	110		1	110		1	30		90				1	2	30		90				30		34	10		30																			10		20																10				10		0.33			0.33			0.29	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5430	1	0	1	1	1	H5430_001_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5430	1	0	1	1	1	H5430_001_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5430	1	0	1	1	1	H5430_001_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5430	1	0	1	1	1	H5430_001_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				82.67	49		49																								49		49				49		49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5430	1	0	1	1	1	H5430_001_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5431	1	0	1	1	1	H5431_001_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	1	0	1	1	1	H5431_001_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H5431	1	0	1	1	1	H5431_001_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	1	0	1	1	1	H5431_001_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H5431	1	0	1	1	1	H5431_001_0	6	Preferred Brand	4	10	1	2	3	1		10	1	10		1				30					30						30		34								20							0							0																		20				20			0.67	0	0			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	1	0	1	1	1	H5431_001_0	6	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								35							25							25																		35				35			1.17	0.83	0.83			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	1	0	1	1	1	H5431_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	1	0	1	1	1	H5431_001_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1		10	1	10		1				30					30						30		34								0							0							0																		0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	6	0	1	1	1	H5431_006_0	7	Preferred Generic	4	1	1	1	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				2.02	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	6	0	1	1	1	H5431_006_0	7	Generic	4	1	1	1	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				8	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	6	0	1	1	1	H5431_006_0	7	Preferred Brand	4	10	1	1	3	1	10		1	10		1	30								30						30		34				71.24	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	6	0	1	1	1	H5431_006_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1	10		1	30								30						30		34				38.66	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	6	0	1	1	1	H5431_006_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	6	0	1	1	1	H5431_006_0	7	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	10		1	10		1	30								30						30		34	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	12	0	1	1	1	H5431_012_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	12	0	1	1	1	H5431_012_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H5431	12	0	1	1	1	H5431_012_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	12	0	1	1	1	H5431_012_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H5431	12	0	1	1	1	H5431_012_0	6	Preferred Brand	4	10	1	2	3	1		10	1	10		1				30					30						30		34								20							15							15																		20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	12	0	1	1	1	H5431_012_0	6	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								35							30							30																		35				35			1.17	1	1			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	12	0	1	1	1	H5431_012_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	12	0	1	1	1	H5431_012_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1		10	1	10		1				30					30						30		34								0							0							0																		0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	13	0	1	1	1	H5431_013_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	13	0	1	1	1	H5431_013_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H5431	13	0	1	1	1	H5431_013_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	13	0	1	1	1	H5431_013_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"										1		
H5431	13	0	1	1	1	H5431_013_0	6	Preferred Brand	4	10	1	2	3	1		10	1	10		1				30					30						30		34								20							15							15																		20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	13	0	1	1	1	H5431_013_0	6	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								35							30							30																		35				35			1.17	1	1			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	13	0	1	1	1	H5431_013_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	13	0	1	1	1	H5431_013_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1		10	1	10		1				30					30						30		34								0							0							0																		0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	14	0	1	1	1	H5431_014_0	6	Preferred Generic	4	1	1	1	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				2.17	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	14	0	1	1	1	H5431_014_0	6	Generic	4	1	1	1	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				8.51	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	14	0	1	1	1	H5431_014_0	6	Preferred Brand	4	10	1	1	3	1	10		1	10		1	30								30						30		34				75.25	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	14	0	1	1	1	H5431_014_0	6	Non-Preferred Brand	4	10	1	1	4	1	10		1	10		1	30								30						30		34				41.22	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	14	0	1	1	1	H5431_014_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5431	14	0	1	1	1	H5431_014_0	6	Supplemental Brand and Generic Drugs	4	11	2	2	6	1	10		1	10		1	30								30						30		34	0																					0																		0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs"												
H5433	1	0	1	1	1	H5433_001_0	4	Generic	4	11	1	2	1	1	10		1			1	30														30		31	0																																							0				0		0						0	"Generic, Brand"												
H5433	1	0	1	1	1	H5433_001_0	4	Brand	4	11	1	2	2	1	10		1			1	30														30		31	0																																							0				0		0						0	"Generic, Brand"												
H5434	2	0	1	4	1	H5434_002_0	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								13		39					3		9					3		9																13				3			0.42	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5434	2	0	1	4	1	H5434_002_0	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								13		39					3		9					3		9																13				3			0.42	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5434	2	0	1	4	1	H5434_002_0	11	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5434	2	0	1	4	1	H5434_002_0	11	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					40		120					40		120																47				40			1.52	1.29	1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5434	2	0	1	4	1	H5434_002_0	11	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5434	2	0	1	4	1	H5434_002_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											765.5	27						765.5	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5434	2	0	1	4	1	H5434_002_0	11	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5434	2	0	1	4	1	H5434_002_0	11	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5434	23	0	1	4	1	H5434_023_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	23	0	1	4	1	H5434_023_0	7	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	23	0	1	4	1	H5434_023_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		30																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	23	0	1	4	1	H5434_023_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	23	0	1	4	1	H5434_023_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	23	0	1	4	1	H5434_023_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1089.26	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	23	0	1	4	1	H5434_023_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	23	0	1	4	1	H5434_023_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	24	0	1	4	1	H5434_024_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	24	0	1	4	1	H5434_024_0	7	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	24	0	1	4	1	H5434_024_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		30																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	24	0	1	4	1	H5434_024_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	24	0	1	4	1	H5434_024_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	24	0	1	4	1	H5434_024_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1194.85	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	24	0	1	4	1	H5434_024_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	24	0	1	4	1	H5434_024_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	25	0	1	4	1	H5434_025_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	25	0	1	4	1	H5434_025_0	7	Preferred Generic	4	1	1	2	1	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	25	0	1	4	1	H5434_025_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		30																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	25	0	1	4	1	H5434_025_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	25	0	1	4	1	H5434_025_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	25	0	1	4	1	H5434_025_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1144.27	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	25	0	1	4	1	H5434_025_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	25	0	1	4	1	H5434_025_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	26	0	1	4	1	H5434_026_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	2		6																			2		6																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	26	0	1	4	1	H5434_026_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		30																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	26	0	1	4	1	H5434_026_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	26	0	1	4	1	H5434_026_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	26	0	1	4	1	H5434_026_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				891.86	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	26	0	1	4	1	H5434_026_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	26	0	1	4	1	H5434_026_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	30	0	1	4	1	H5434_030_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	2		6																			2		6																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	30	0	1	4	1	H5434_030_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	30	0	1	4	1	H5434_030_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	30	0	1	4	1	H5434_030_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	30	0	1	4	1	H5434_030_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1329.6	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	30	0	1	4	1	H5434_030_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	30	0	1	4	1	H5434_030_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	31	0	1	4	1	H5434_031_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	2		6																			2		6																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	31	0	1	4	1	H5434_031_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	31	0	1	4	1	H5434_031_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	31	0	1	4	1	H5434_031_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	31	0	1	4	1	H5434_031_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				819.45	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	31	0	1	4	1	H5434_031_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	31	0	1	4	1	H5434_031_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	32	0	1	4	1	H5434_032_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	2		6																			2		6																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	32	0	1	4	1	H5434_032_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	10		30																			10		30																10				10		0.32			0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	32	0	1	4	1	H5434_032_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	32	0	1	4	1	H5434_032_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	32	0	1	4	1	H5434_032_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				989.26	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	32	0	1	4	1	H5434_032_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	32	0	1	4	1	H5434_032_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	33	0	1	4	1	H5434_033_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	3		9																			3		9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	33	0	1	4	1	H5434_033_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	33	0	1	4	1	H5434_033_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	33	0	1	4	1	H5434_033_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	33	0	1	4	1	H5434_033_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				841.93	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	33	0	1	4	1	H5434_033_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	33	0	1	4	1	H5434_033_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	34	0	1	4	1	H5434_034_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	3		9																			3		9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	34	0	1	4	1	H5434_034_0	7	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	34	0	1	4	1	H5434_034_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	34	0	1	4	1	H5434_034_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	34	0	1	4	1	H5434_034_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1088	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	34	0	1	4	1	H5434_034_0	7	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	34	0	1	4	1	H5434_034_0	7	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5434	35	0	1	4	1	H5434_035_0	8	Preferred Generic	4	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	2		6																			2		6																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	35	0	1	4	1	H5434_035_0	8	Generic	4	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	12		36																			12		36																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	35	0	1	4	1	H5434_035_0	8	Preferred Brand	4	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	35	0	1	4	1	H5434_035_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	31		90				1	2	31		90				31		31	100		300																			100		300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	35	0	1	4	1	H5434_035_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1123.8	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	35	0	1	4	1	H5434_035_0	8	Select Care Drugs	4	1	1	2	6	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5434	35	0	1	4	1	H5434_035_0	8	Select Care Drugs	4	1	1	2	6	3	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5435	24	0	1	9	4	H5435_024_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5435	24	0	1	9	4	H5435_024_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5435	24	0	1	9	4	H5435_024_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5435	24	0	1	9	4	H5435_024_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5435	24	0	1	9	4	H5435_024_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				746	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5439	11	0	1	4	1	H5439_011_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	11	0	1	4	1	H5439_011_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	11	0	1	4	1	H5439_011_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	11	0	1	4	1	H5439_011_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	11	0	1	4	1	H5439_011_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	11	0	1	4	1	H5439_011_0	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	13	0	1	4	1	H5439_013_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	13	0	1	4	1	H5439_013_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	13	0	1	4	1	H5439_013_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	13	0	1	4	1	H5439_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	13	0	1	4	1	H5439_013_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	13	0	1	4	1	H5439_013_0	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	1	1	4	1	H5439_014_1	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	1	1	4	1	H5439_014_1	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	1	1	4	1	H5439_014_1	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	1	1	4	1	H5439_014_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	1	1	4	1	H5439_014_1	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	1	1	4	1	H5439_014_1	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	2	1	4	1	H5439_014_2	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	2	1	4	1	H5439_014_2	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	2	1	4	1	H5439_014_2	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	2	1	4	1	H5439_014_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	2	1	4	1	H5439_014_2	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	2	1	4	1	H5439_014_2	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	3	1	4	1	H5439_014_3	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	3	1	4	1	H5439_014_3	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	3	1	4	1	H5439_014_3	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	3	1	4	1	H5439_014_3	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	3	1	4	1	H5439_014_3	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	3	1	4	1	H5439_014_3	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	4	1	4	1	H5439_014_4	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	4	1	4	1	H5439_014_4	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	4	1	4	1	H5439_014_4	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	4	1	4	1	H5439_014_4	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	4	1	4	1	H5439_014_4	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	14	4	1	4	1	H5439_014_4	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	15	0	1	4	1	H5439_015_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	15	0	1	4	1	H5439_015_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	15	0	1	4	1	H5439_015_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	15	0	1	4	1	H5439_015_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	15	0	1	4	1	H5439_015_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	15	0	1	4	1	H5439_015_0	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	1	1	4	1	H5439_016_1	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	1	1	4	1	H5439_016_1	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	1	1	4	1	H5439_016_1	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	1	1	4	1	H5439_016_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	1	1	4	1	H5439_016_1	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	1	1	4	1	H5439_016_1	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	2	1	4	1	H5439_016_2	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	2	1	4	1	H5439_016_2	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	2	1	4	1	H5439_016_2	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	2	1	4	1	H5439_016_2	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	2	1	4	1	H5439_016_2	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	16	2	1	4	1	H5439_016_2	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	17	0	1	4	1	H5439_017_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	17	0	1	4	1	H5439_017_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					8	16	24					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	17	0	1	4	1	H5439_017_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	17	0	1	4	1	H5439_017_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	17	0	1	4	1	H5439_017_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5439	17	0	1	4	1	H5439_017_0	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5454	1	0	1	1	1	H5454_001_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	3		9																			3		0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	1	0	1	1	1	H5454_001_0	6	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	12		36																			12		0																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	1	0	1	1	1	H5454_001_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		131																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	1	0	1	1	1	H5454_001_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		290																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	1	0	1	1	1	H5454_001_0	6	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				50	33		33																		33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	2	0	1	1	1	H5454_002_0	7	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	3		9																			3		0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	2	0	1	1	1	H5454_002_0	7	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	12		36																			12		0																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	2	0	1	1	1	H5454_002_0	7	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		131																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	2	0	1	1	1	H5454_002_0	7	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		290																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	2	0	1	1	1	H5454_002_0	7	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				50	33		33																		33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	3	0	1	1	1	H5454_003_0	5	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	3	0	1	1	1	H5454_003_0	5	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	6		12																			6		12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	3	0	1	1	1	H5454_003_0	5	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	35		70																			35		70																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	3	0	1	1	1	H5454_003_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	85		255																			85		225																85				85		2.83			2.83			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	3	0	1	1	1	H5454_003_0	5	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				50	33		33																		33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	4	0	1	1	1	H5454_004_0	5	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	4	0	1	1	1	H5454_004_0	5	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	6		12																			6		12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	4	0	1	1	1	H5454_004_0	5	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	35		70																			35		70																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	4	0	1	1	1	H5454_004_0	5	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	85		255																			85		225																85				85		2.83			2.83			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5454	4	0	1	1	1	H5454_004_0	5	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				50	33		33																		33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5471	64	0	1	1	1	H5471_064_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	64	0	1	1	1	H5471_064_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	64	0	1	1	1	H5471_064_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	64	0	1	1	1	H5471_064_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	64	0	1	1	1	H5471_064_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	64	0	1	1	1	H5471_064_0	7	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								100							95							95																		100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	64	0	1	1	1	H5471_064_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	65	0	1	1	1	H5471_065_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	65	0	1	1	1	H5471_065_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	65	0	1	1	1	H5471_065_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	65	0	1	1	1	H5471_065_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	65	0	1	1	1	H5471_065_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	65	0	1	1	1	H5471_065_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	5																					5																		5				5		0.17			0.17			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	65	0	1	1	1	H5471_065_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	66	0	1	1	1	H5471_066_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	66	0	1	1	1	H5471_066_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	66	0	1	1	1	H5471_066_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	66	0	1	1	1	H5471_066_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	66	0	1	1	1	H5471_066_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	66	0	1	1	1	H5471_066_0	7	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								100							95							95																		100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	66	0	1	1	1	H5471_066_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	67	0	1	1	1	H5471_067_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	4	8	12																																					4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	67	0	1	1	1	H5471_067_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	67	0	1	1	1	H5471_067_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				42.41	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	67	0	1	1	1	H5471_067_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				56.35	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	67	0	1	1	1	H5471_067_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	68	0	1	1	1	H5471_068_0	8	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	68	0	1	1	1	H5471_068_0	8	Preferred Generic	4	1	1	2	1	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	68	0	1	1	1	H5471_068_0	8	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	68	0	1	1	1	H5471_068_0	8	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				46.99	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	68	0	1	1	1	H5471_068_0	8	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				16.22	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	68	0	1	1	1	H5471_068_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	69	0	1	1	1	H5471_069_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	69	0	1	1	1	H5471_069_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	69	0	1	1	1	H5471_069_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	69	0	1	1	1	H5471_069_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	69	0	1	1	1	H5471_069_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	69	0	1	1	1	H5471_069_0	7	Preferred Brand	4	10	1	2	3	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	69	0	1	1	1	H5471_069_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	10																					10																		10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	69	0	1	1	1	H5471_069_0	7	Non-Preferred Brand	4	10	1	2	4	3	10		1	10		1	30								30						30		34	10																					10																		10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	69	0	1	1	1	H5471_069_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	70	0	1	1	1	H5471_070_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	70	0	1	1	1	H5471_070_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	70	0	1	1	1	H5471_070_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	70	0	1	1	1	H5471_070_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	70	0	1	1	1	H5471_070_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	70	0	1	1	1	H5471_070_0	7	Preferred Brand	4	10	1	2	3	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	70	0	1	1	1	H5471_070_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	40																					40																		40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	70	0	1	1	1	H5471_070_0	7	Non-Preferred Brand	4	10	1	2	4	3	10		1	10		1	30								30						30		34	40																					40																		40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	70	0	1	1	1	H5471_070_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	71	0	1	1	1	H5471_071_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	71	0	1	1	1	H5471_071_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	71	0	1	1	1	H5471_071_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	71	0	1	1	1	H5471_071_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	71	0	1	1	1	H5471_071_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	10	20	30																			10	30	30																10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	71	0	1	1	1	H5471_071_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	55																					55																		55				55		1.83			1.83			1.62	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	71	0	1	1	1	H5471_071_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	72	0	1	1	1	H5471_072_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	72	0	1	1	1	H5471_072_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	72	0	1	1	1	H5471_072_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	72	0	1	1	1	H5471_072_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	72	0	1	1	1	H5471_072_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	72	0	1	1	1	H5471_072_0	7	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								100							95							95																		100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	72	0	1	1	1	H5471_072_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	73	0	1	1	1	H5471_073_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	73	0	1	1	1	H5471_073_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	73	0	1	1	1	H5471_073_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	73	0	1	1	1	H5471_073_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	73	0	1	1	1	H5471_073_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	25	50	75																			25	75	75																25				25		0.83			0.83			0.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	73	0	1	1	1	H5471_073_0	7	Preferred Brand	4	10	1	2	3	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	25	50	75																			25	75	75																25				25		0.83			0.83			0.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	73	0	1	1	1	H5471_073_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	73	0	1	1	1	H5471_073_0	7	Non-Preferred Brand	4	10	1	2	4	3	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	73	0	1	1	1	H5471_073_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	74	0	1	1	1	H5471_074_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	74	0	1	1	1	H5471_074_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	74	0	1	1	1	H5471_074_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	74	0	1	1	1	H5471_074_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	74	0	1	1	1	H5471_074_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	25	50	75																			25	75	75																25				25		0.83			0.83			0.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	74	0	1	1	1	H5471_074_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	74	0	1	1	1	H5471_074_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	75	0	1	1	1	H5471_075_0	9	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	75	0	1	1	1	H5471_075_0	9	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	75	0	1	1	1	H5471_075_0	9	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	75	0	1	1	1	H5471_075_0	9	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	75	0	1	1	1	H5471_075_0	9	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	35	70	105																			35	105	105																35				35		1.17			1.17			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	75	0	1	1	1	H5471_075_0	9	Preferred Brand	4	10	1	2	3	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	35	70	105																			35	105	105																35				35		1.17			1.17			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	75	0	1	1	1	H5471_075_0	9	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	75	0	1	1	1	H5471_075_0	9	Non-Preferred Brand	4	10	1	2	4	3	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	75	0	1	1	1	H5471_075_0	9	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	76	0	1	1	1	H5471_076_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	76	0	1	1	1	H5471_076_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	76	0	1	1	1	H5471_076_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	76	0	1	1	1	H5471_076_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	76	0	1	1	1	H5471_076_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	76	0	1	1	1	H5471_076_0	7	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								100							95							95																		100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	76	0	1	1	1	H5471_076_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	77	0	1	1	1	H5471_077_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	77	0	1	1	1	H5471_077_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	77	0	1	1	1	H5471_077_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	77	0	1	1	1	H5471_077_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	77	0	1	1	1	H5471_077_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	25	50	75																			25	75	75																25				25		0.83			0.83			0.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	77	0	1	1	1	H5471_077_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	77	0	1	1	1	H5471_077_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	78	0	1	1	1	H5471_078_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	78	0	1	1	1	H5471_078_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	78	0	1	1	1	H5471_078_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	78	0	1	1	1	H5471_078_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	78	0	1	1	1	H5471_078_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	35	70	105																			35	105	105																35				35		1.17			1.17			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	78	0	1	1	1	H5471_078_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	78	0	1	1	1	H5471_078_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	79	0	1	1	1	H5471_079_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	4	8	12																																					4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	79	0	1	1	1	H5471_079_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	79	0	1	1	1	H5471_079_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				42.86	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	79	0	1	1	1	H5471_079_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				58.45	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	79	0	1	1	1	H5471_079_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	80	0	1	1	1	H5471_080_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	80	0	1	1	1	H5471_080_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	80	0	1	1	1	H5471_080_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	80	0	1	1	1	H5471_080_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	80	0	1	1	1	H5471_080_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	35	70	105																			35	105	105																35				35		1.17			1.17			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	80	0	1	1	1	H5471_080_0	7	Preferred Brand	4	10	1	2	3	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	35	70	105																			35	105	105																35				35		1.17			1.17			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	80	0	1	1	1	H5471_080_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	80	0	1	1	1	H5471_080_0	7	Non-Preferred Brand	4	10	1	2	4	3	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	80	0	1	1	1	H5471_080_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	81	0	1	1	1	H5471_081_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	81	0	1	1	1	H5471_081_0	7	Preferred Generic	4	1	1	2	1	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	81	0	1	1	1	H5471_081_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	81	0	1	1	1	H5471_081_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				43.23	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	81	0	1	1	1	H5471_081_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				58.22	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	81	0	1	1	1	H5471_081_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	82	0	1	1	1	H5471_082_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	82	0	1	1	1	H5471_082_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	82	0	1	1	1	H5471_082_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	82	0	1	1	1	H5471_082_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	82	0	1	1	1	H5471_082_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	82	0	1	1	1	H5471_082_0	7	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								100							95							95																		100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	82	0	1	1	1	H5471_082_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	83	0	1	1	1	H5471_083_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	83	0	1	1	1	H5471_083_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	83	0	1	1	1	H5471_083_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	83	0	1	1	1	H5471_083_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	83	0	1	1	1	H5471_083_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	20	40	60																			20	60	60																20				20		0.67			0.67			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	83	0	1	1	1	H5471_083_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	83	0	1	1	1	H5471_083_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	84	0	1	1	1	H5471_084_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	84	0	1	1	1	H5471_084_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	84	0	1	1	1	H5471_084_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	84	0	1	1	1	H5471_084_0	7	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	84	0	1	1	1	H5471_084_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	84	0	1	1	1	H5471_084_0	7	Non-Preferred Brand	4	10	1	2	4	1		10	1	10		1				30					30						30		34								100							95							95																		100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	84	0	1	1	1	H5471_084_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	85	0	1	1	1	H5471_085_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	85	0	1	1	1	H5471_085_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	85	0	1	1	1	H5471_085_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	85	0	1	1	1	H5471_085_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	85	0	1	1	1	H5471_085_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	35	70	105																			35	105	105																35				35		1.17			1.17			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	85	0	1	1	1	H5471_085_0	7	Preferred Brand	4	10	1	2	3	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	35	70	105																			35	105	105																35				35		1.17			1.17			1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	85	0	1	1	1	H5471_085_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	85	0	1	1	1	H5471_085_0	7	Non-Preferred Brand	4	10	1	2	4	3	10		1	10		1	30								30						30		34	75																					75																		75				75		2.5			2.5			2.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H5471	85	0	1	1	1	H5471_085_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	90	0	1	1	1	H5471_090_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	90	0	1	1	1	H5471_090_0	7	Preferred Generic	4	1	1	2	1	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	90	0	1	1	1	H5471_090_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	10	20	30																																					10				10		0.33						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	90	0	1	1	1	H5471_090_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				43.11	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	90	0	1	1	1	H5471_090_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				58.11	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	90	0	1	1	1	H5471_090_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	91	0	1	1	1	H5471_091_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	91	0	1	1	1	H5471_091_0	7	Preferred Generic	4	1	1	2	1	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	91	0	1	1	1	H5471_091_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	91	0	1	1	1	H5471_091_0	7	Generic	4	1	1	2	2	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	91	0	1	1	1	H5471_091_0	7	Preferred Brand	4	10	1	2	3	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	91	0	1	1	1	H5471_091_0	7	Preferred Brand	4	10	1	2	3	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	91	0	1	1	1	H5471_091_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				58.19	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	91	0	1	1	1	H5471_091_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	92	0	1	1	1	H5471_092_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	4	8	12																																					4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	92	0	1	1	1	H5471_092_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	92	0	1	1	1	H5471_092_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				42.56	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	92	0	1	1	1	H5471_092_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				57.53	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	92	0	1	1	1	H5471_092_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	93	0	1	1	1	H5471_093_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	93	0	1	1	1	H5471_093_0	7	Preferred Generic	4	1	1	2	1	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	93	0	1	1	1	H5471_093_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	93	0	1	1	1	H5471_093_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				42.42	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	93	0	1	1	1	H5471_093_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				57.36	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	93	0	1	1	1	H5471_093_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	94	0	1	1	1	H5471_094_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	4	8	12																																					4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	94	0	1	1	1	H5471_094_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	94	0	1	1	1	H5471_094_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				42.46	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	94	0	1	1	1	H5471_094_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				57.4	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	94	0	1	1	1	H5471_094_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	95	0	1	1	1	H5471_095_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	95	0	1	1	1	H5471_095_0	7	Preferred Generic	4	1	1	2	1	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	95	0	1	1	1	H5471_095_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	95	0	1	1	1	H5471_095_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				43.94	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	95	0	1	1	1	H5471_095_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				58.94	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	95	0	1	1	1	H5471_095_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	96	0	1	1	1	H5471_096_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	4	8	12																																					4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	96	0	1	1	1	H5471_096_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	6	12	18																																					6				6		0.2						0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	96	0	1	1	1	H5471_096_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				44.33	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	96	0	1	1	1	H5471_096_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				60.04	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	96	0	1	1	1	H5471_096_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	97	0	1	1	1	H5471_097_0	7	Preferred Generic	4	1	1	2	1	1	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	97	0	1	1	1	H5471_097_0	7	Preferred Generic	4	1	1	2	1	3	111		1			1	30	60	90				2	2							30		34	0	0	0																																					0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	97	0	1	1	1	H5471_097_0	7	Generic	4	1	1	2	2	1	111		1			1	30	60	90				2	2							30		34	5	10	15																																					5				5		0.17						0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	97	0	1	1	1	H5471_097_0	7	Preferred Brand	4	10	1	1	3	1	111		1			1	30	60	90				2	2							30		34				44.47	25	25	25																																			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	97	0	1	1	1	H5471_097_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1			1	30														30		34				60.16	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	97	0	1	1	1	H5471_097_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		34					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	98	0	1	1	1	H5471_098_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	98	0	1	1	1	H5471_098_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	98	0	1	1	1	H5471_098_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	98	0	1	1	1	H5471_098_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	98	0	1	1	1	H5471_098_0	7	Preferred Brand	4	10	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				65.91	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	98	0	1	1	1	H5471_098_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1	10		1	30								30						30		34				19.87	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	98	0	1	1	1	H5471_098_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	99	0	1	1	1	H5471_099_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	99	0	1	1	1	H5471_099_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	99	0	1	1	1	H5471_099_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	99	0	1	1	1	H5471_099_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	99	0	1	1	1	H5471_099_0	7	Preferred Brand	4	10	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				68.39	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	99	0	1	1	1	H5471_099_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1	10		1	30								30						30		34				20.25	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	99	0	1	1	1	H5471_099_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	100	0	1	1	1	H5471_100_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	100	0	1	1	1	H5471_100_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	100	0	1	1	1	H5471_100_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	100	0	1	1	1	H5471_100_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	100	0	1	1	1	H5471_100_0	7	Preferred Brand	4	10	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				69.82	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	100	0	1	1	1	H5471_100_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1	10		1	30								30						30		34				20.98	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	100	0	1	1	1	H5471_100_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	101	0	1	1	1	H5471_101_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	101	0	1	1	1	H5471_101_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	101	0	1	1	1	H5471_101_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	101	0	1	1	1	H5471_101_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	101	0	1	1	1	H5471_101_0	7	Preferred Brand	4	10	1	1	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34				70.86	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	101	0	1	1	1	H5471_101_0	7	Non-Preferred Brand	4	10	1	1	4	1	10		1	10		1	30								30						30		34				21.12	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	101	0	1	1	1	H5471_101_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	103	0	1	1	1	H5471_103_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	103	0	1	1	1	H5471_103_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	103	0	1	1	1	H5471_103_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	10	20	30																			10	30	30																10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	103	0	1	1	1	H5471_103_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	10	20	30																			10	30	30																10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	103	0	1	1	1	H5471_103_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	47	94	141																			47	141	141																47				47		1.57			1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	103	0	1	1	1	H5471_103_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	100																					100																		100				100		3.33			3.33			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	103	0	1	1	1	H5471_103_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	104	0	1	1	1	H5471_104_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	5	10	15																			5	15	15																5				5		0.17			0.17			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	104	0	1	1	1	H5471_104_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	5	10	15																			5	15	15																5				5		0.17			0.17			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	104	0	1	1	1	H5471_104_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	20	40	60																			20	60	60																20				20		0.67			0.67			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	104	0	1	1	1	H5471_104_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	20	40	60																			20	60	60																20				20		0.67			0.67			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	104	0	1	1	1	H5471_104_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	47	94	141																			47	141	141																47				47		1.57			1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	104	0	1	1	1	H5471_104_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	100																					100																		100				100		3.33			3.33			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	104	0	1	1	1	H5471_104_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	105	0	1	1	1	H5471_105_0	7	Preferred Generic	4	1	3	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	10	20	30																			10	30	30																10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	105	0	1	1	1	H5471_105_0	7	Preferred Generic	4	1	3	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	10	20	30																			10	30	30																10				10		0.33			0.33			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5471	105	0	1	1	1	H5471_105_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	20	40	60																			20	60	60																20				20		0.67			0.67			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	105	0	1	1	1	H5471_105_0	7	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	20	40	60																			20	60	60																20				20		0.67			0.67			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5471	105	0	1	1	1	H5471_105_0	7	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	47	94	141																			47	141	141																47				47		1.57			1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	105	0	1	1	1	H5471_105_0	7	Non-Preferred Brand	4	10	1	2	4	1	10		1	10		1	30								30						30		34	100																					100																		100				100		3.33			3.33			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5471	105	0	1	1	1	H5471_105_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5475	1	0	1	2	1	H5475_001_0	5	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	1	0	1	2	1	H5475_001_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	1	0	1	2	1	H5475_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	1	0	1	2	1	H5475_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		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"												
H5475	1	0	1	2	1	H5475_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	3	0	1	2	1	H5475_003_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	3	0	1	2	1	H5475_003_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	3	0	1	2	1	H5475_003_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	3	0	1	2	1	H5475_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	3	0	1	2	1	H5475_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	4	0	1	2	1	H5475_004_0	5	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	4	0	1	2	1	H5475_004_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	4	0	1	2	1	H5475_004_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	4	0	1	2	1	H5475_004_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.9	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	4	0	1	2	1	H5475_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	5	0	1	2	1	H5475_005_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	5	0	1	2	1	H5475_005_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	18		54																									18		54				18		0				18				18		0.6				0.6	0.6	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	5	0	1	2	1	H5475_005_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	5	0	1	2	1	H5475_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	5	0	1	2	1	H5475_005_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	6	0	1	2	1	H5475_006_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	6	0	1	2	1	H5475_006_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	6	0	1	2	1	H5475_006_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	6	0	1	2	1	H5475_006_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	6	0	1	2	1	H5475_006_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	8	0	1	2	1	H5475_008_0	5	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	8	0	1	2	1	H5475_008_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	8	0	1	2	1	H5475_008_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	8	0	1	2	1	H5475_008_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				75.41	37		37																								37		37				37		37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	8	0	1	2	1	H5475_008_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	9	0	1	2	1	H5475_009_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	9	0	1	2	1	H5475_009_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	9	0	1	2	1	H5475_009_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	9	0	1	2	1	H5475_009_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	9	0	1	2	1	H5475_009_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	10	0	1	2	1	H5475_010_0	6	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	10	0	1	2	1	H5475_010_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	10	0	1	2	1	H5475_010_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	10	0	1	2	1	H5475_010_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.42	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	10	0	1	2	1	H5475_010_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	11	0	1	2	1	H5475_011_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	11	0	1	2	1	H5475_011_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	11	0	1	2	1	H5475_011_0	6	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	11	0	1	2	1	H5475_011_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	11	0	1	2	1	H5475_011_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	12	0	1	2	1	H5475_012_0	5	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	12	0	1	2	1	H5475_012_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	12	0	1	2	1	H5475_012_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	12	0	1	2	1	H5475_012_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	12	0	1	2	1	H5475_012_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	13	0	1	2	1	H5475_013_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	13	0	1	2	1	H5475_013_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	13	0	1	2	1	H5475_013_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	13	0	1	2	1	H5475_013_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	13	0	1	2	1	H5475_013_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	15	0	1	2	1	H5475_015_0	6	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	15	0	1	2	1	H5475_015_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	15	0	1	2	1	H5475_015_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	15	0	1	2	1	H5475_015_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	15	0	1	2	1	H5475_015_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	16	0	1	2	1	H5475_016_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	16	0	1	2	1	H5475_016_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	16	0	1	2	1	H5475_016_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	16	0	1	2	1	H5475_016_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	16	0	1	2	1	H5475_016_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	19	0	1	2	1	H5475_019_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	19	0	1	2	1	H5475_019_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	19	0	1	2	1	H5475_019_0	5	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	19	0	1	2	1	H5475_019_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	19	0	1	2	1	H5475_019_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	20	0	1	2	1	H5475_020_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	20	0	1	2	1	H5475_020_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	20	0	1	2	1	H5475_020_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	20	0	1	2	1	H5475_020_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	20	0	1	2	1	H5475_020_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	21	0	1	2	1	H5475_021_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	21	0	1	2	1	H5475_021_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	21	0	1	2	1	H5475_021_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	21	0	1	2	1	H5475_021_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	21	0	1	2	1	H5475_021_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	22	0	1	2	1	H5475_022_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	22	0	1	2	1	H5475_022_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	22	0	1	2	1	H5475_022_0	4	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	22	0	1	2	1	H5475_022_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	22	0	1	2	1	H5475_022_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	23	0	1	2	1	H5475_023_0	5	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	23	0	1	2	1	H5475_023_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	23	0	1	2	1	H5475_023_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	23	0	1	2	1	H5475_023_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	23	0	1	2	1	H5475_023_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	24	0	1	2	1	H5475_024_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	24	0	1	2	1	H5475_024_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	24	0	1	2	1	H5475_024_0	4	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	24	0	1	2	1	H5475_024_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	24	0	1	2	1	H5475_024_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	26	0	1	2	1	H5475_026_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	26	0	1	2	1	H5475_026_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	26	0	1	2	1	H5475_026_0	4	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	26	0	1	2	1	H5475_026_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	26	0	1	2	1	H5475_026_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	27	0	1	2	1	H5475_027_0	4	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	27	0	1	2	1	H5475_027_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	27	0	1	2	1	H5475_027_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	27	0	1	2	1	H5475_027_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	27	0	1	2	1	H5475_027_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	28	0	1	2	1	H5475_028_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	28	0	1	2	1	H5475_028_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	28	0	1	2	1	H5475_028_0	4	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	28	0	1	2	1	H5475_028_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	28	0	1	2	1	H5475_028_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	29	0	1	2	1	H5475_029_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	29	0	1	2	1	H5475_029_0	4	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5475	29	0	1	2	1	H5475_029_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	29	0	1	2	1	H5475_029_0	4	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5475	29	0	1	2	1	H5475_029_0	4	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	29	0	1	2	1	H5475_029_0	4	Preferred Brand	4	11	3	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	35		105																									35		105				35		70				35				35		1.17				1.17	1.17	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	3
H5475	29	0	1	2	1	H5475_029_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	29	0	1	2	1	H5475_029_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	30	0	1	2	1	H5475_030_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	30	0	1	2	1	H5475_030_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	30	0	1	2	1	H5475_030_0	4	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	30	0	1	2	1	H5475_030_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	30	0	1	2	1	H5475_030_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	31	0	1	1	1	H5475_031_0	4	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	31	0	1	1	1	H5475_031_0	4	Generic	2	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	4		12																									4		12				4		0				4				4		0.13				0.13	0.13	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	31	0	1	1	1	H5475_031_0	4	Preferred Brand	2	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	31	0	1	1	1	H5475_031_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	31	0	1	1	1	H5475_031_0	4	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	32	0	1	1	1	H5475_032_0	4	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	32	0	1	1	1	H5475_032_0	4	Generic	2	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	4		12																									4		12				4		0				4				4		0.13				0.13	0.13	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	32	0	1	1	1	H5475_032_0	4	Preferred Brand	2	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	32	0	1	1	1	H5475_032_0	4	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.34	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5475	32	0	1	1	1	H5475_032_0	4	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	5	0	1	1	1	H5496_005_0	5	Preferred Generic	4	11	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5496	5	0	1	1	1	H5496_005_0	5	Preferred Generic	4	11	1	1	1	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5496	5	0	1	1	1	H5496_005_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	5		12																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5496	5	0	1	1	1	H5496_005_0	5	Generic	4	11	1	1	2	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5496	5	0	1	1	1	H5496_005_0	5	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		110																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5496	5	0	1	1	1	H5496_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		225																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5496	5	0	1	1	1	H5496_005_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1219.32	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5496	5	0	1	1	1	H5496_005_0	5	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	3		6																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5496	7	0	1	1	1	H5496_007_0	5	Preferred Generic	4	11	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	7	0	1	1	1	H5496_007_0	5	Preferred Generic	4	11	1	1	1	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5496	7	0	1	1	1	H5496_007_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	5		12																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	7	0	1	1	1	H5496_007_0	5	Generic	4	11	1	1	2	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5496	7	0	1	1	1	H5496_007_0	5	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		110																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	7	0	1	1	1	H5496_007_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		225																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	7	0	1	1	1	H5496_007_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				591.84	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	9	0	1	1	1	H5496_009_0	5	Preferred Generic	4	11	1	1	1	1	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	9	0	1	1	1	H5496_009_0	5	Preferred Generic	4	11	1	1	1	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5496	9	0	1	1	1	H5496_009_0	5	Generic	4	11	1	1	2	1	110		1	100		1	30		90				1	2			90				30		31				8.98	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	9	0	1	1	1	H5496_009_0	5	Generic	4	11	1	1	2	3	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5496	9	0	1	1	1	H5496_009_0	5	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		31				96.85	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	9	0	1	1	1	H5496_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		31				38.33	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5496	9	0	1	1	1	H5496_009_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				630.64	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5521	12	0	1	4	1	H5521_012_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	12	0	1	4	1	H5521_012_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	12	0	1	4	1	H5521_012_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	12	0	1	4	1	H5521_012_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	12	0	1	4	1	H5521_012_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	12	0	1	4	1	H5521_012_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	12	0	1	4	1	H5521_012_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											913.48	33						891	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	13	0	1	4	1	H5521_013_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	13	0	1	4	1	H5521_013_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	13	0	1	4	1	H5521_013_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	13	0	1	4	1	H5521_013_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	13	0	1	4	1	H5521_013_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	13	0	1	4	1	H5521_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	13	0	1	4	1	H5521_013_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											576.54	28						559.87	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	15	0	1	4	1	H5521_015_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	15	0	1	4	1	H5521_015_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	15	0	1	4	1	H5521_015_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	15	0	1	4	1	H5521_015_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	15	0	1	4	1	H5521_015_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	15	0	1	4	1	H5521_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	15	0	1	4	1	H5521_015_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											497.28	33						469.06	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	16	0	1	4	1	H5521_016_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	16	0	1	4	1	H5521_016_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	16	0	1	4	1	H5521_016_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	16	0	1	4	1	H5521_016_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	16	0	1	4	1	H5521_016_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	16	0	1	4	1	H5521_016_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	16	0	1	4	1	H5521_016_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											549.92	33						521.3	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	20	0	1	4	1	H5521_020_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	20	0	1	4	1	H5521_020_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	20	0	1	4	1	H5521_020_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	20	0	1	4	1	H5521_020_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	20	0	1	4	1	H5521_020_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	20	0	1	4	1	H5521_020_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	20	0	1	4	1	H5521_020_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											793.29	33						754.46	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	22	0	1	4	1	H5521_022_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	22	0	1	4	1	H5521_022_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	22	0	1	4	1	H5521_022_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	22	0	1	4	1	H5521_022_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	22	0	1	4	1	H5521_022_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	22	0	1	4	1	H5521_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	22	0	1	4	1	H5521_022_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											663.77	33						603.9	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	27	0	1	4	1	H5521_027_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	27	0	1	4	1	H5521_027_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	27	0	1	4	1	H5521_027_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	27	0	1	4	1	H5521_027_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	27	0	1	4	1	H5521_027_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	27	0	1	4	1	H5521_027_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	27	0	1	4	1	H5521_027_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											557.78	30						522.83	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	33	0	1	4	1	H5521_033_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	33	0	1	4	1	H5521_033_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	33	0	1	4	1	H5521_033_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	33	0	1	4	1	H5521_033_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	33	0	1	4	1	H5521_033_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	33	0	1	4	1	H5521_033_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	33	0	1	4	1	H5521_033_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											769.73	27						736.52	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	37	0	1	4	1	H5521_037_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	37	0	1	4	1	H5521_037_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	37	0	1	4	1	H5521_037_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	37	0	1	4	1	H5521_037_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	37	0	1	4	1	H5521_037_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	37	0	1	4	1	H5521_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	37	0	1	4	1	H5521_037_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											633.93	28						606.24	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	40	0	1	4	1	H5521_040_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	40	0	1	4	1	H5521_040_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	40	0	1	4	1	H5521_040_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	40	0	1	4	1	H5521_040_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	40	0	1	4	1	H5521_040_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	40	0	1	4	1	H5521_040_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	40	0	1	4	1	H5521_040_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											438.26	28						368.35	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	53	0	1	4	1	H5521_053_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	53	0	1	4	1	H5521_053_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	53	0	1	4	1	H5521_053_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	53	0	1	4	1	H5521_053_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	53	0	1	4	1	H5521_053_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	53	0	1	4	1	H5521_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	53	0	1	4	1	H5521_053_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											558.79	33						542.84	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	55	0	1	4	1	H5521_055_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	55	0	1	4	1	H5521_055_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	55	0	1	4	1	H5521_055_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	55	0	1	4	1	H5521_055_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	55	0	1	4	1	H5521_055_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	55	0	1	4	1	H5521_055_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	55	0	1	4	1	H5521_055_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											834.79	28						782.07	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	56	0	1	4	1	H5521_056_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	56	0	1	4	1	H5521_056_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	56	0	1	4	1	H5521_056_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	56	0	1	4	1	H5521_056_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	56	0	1	4	1	H5521_056_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	56	0	1	4	1	H5521_056_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	56	0	1	4	1	H5521_056_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											936.88	33						890.22	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	57	0	1	4	1	H5521_057_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	57	0	1	4	1	H5521_057_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	57	0	1	4	1	H5521_057_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	57	0	1	4	1	H5521_057_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	57	0	1	4	1	H5521_057_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	57	0	1	4	1	H5521_057_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	57	0	1	4	1	H5521_057_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											536.08	33						494.7	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	76	0	1	4	1	H5521_076_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	76	0	1	4	1	H5521_076_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	76	0	1	4	1	H5521_076_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	76	0	1	4	1	H5521_076_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	76	0	1	4	1	H5521_076_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	76	0	1	4	1	H5521_076_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	76	0	1	4	1	H5521_076_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											592.98	27						567.09	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	77	0	1	4	1	H5521_077_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	77	0	1	4	1	H5521_077_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	77	0	1	4	1	H5521_077_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	77	0	1	4	1	H5521_077_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	77	0	1	4	1	H5521_077_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	77	0	1	4	1	H5521_077_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	77	0	1	4	1	H5521_077_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											712.21	29						720.3	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	81	0	1	4	1	H5521_081_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	81	0	1	4	1	H5521_081_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	81	0	1	4	1	H5521_081_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	81	0	1	4	1	H5521_081_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	81	0	1	4	1	H5521_081_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	81	0	1	4	1	H5521_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	81	0	1	4	1	H5521_081_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											693.29	29						750.79	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	82	0	1	4	1	H5521_082_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	82	0	1	4	1	H5521_082_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	82	0	1	4	1	H5521_082_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	82	0	1	4	1	H5521_082_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	82	0	1	4	1	H5521_082_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	82	0	1	4	1	H5521_082_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	82	0	1	4	1	H5521_082_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											623.34	33						587.77	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	83	0	1	4	1	H5521_083_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	83	0	1	4	1	H5521_083_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	83	0	1	4	1	H5521_083_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	83	0	1	4	1	H5521_083_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	83	0	1	4	1	H5521_083_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	83	0	1	4	1	H5521_083_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	83	0	1	4	1	H5521_083_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											704.03	33						643.39	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	84	0	1	4	1	H5521_084_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	84	0	1	4	1	H5521_084_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	84	0	1	4	1	H5521_084_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	84	0	1	4	1	H5521_084_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	84	0	1	4	1	H5521_084_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	84	0	1	4	1	H5521_084_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	84	0	1	4	1	H5521_084_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											774.22	33						730.54	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	85	0	1	4	1	H5521_085_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	85	0	1	4	1	H5521_085_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	85	0	1	4	1	H5521_085_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	85	0	1	4	1	H5521_085_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	85	0	1	4	1	H5521_085_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	85	0	1	4	1	H5521_085_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	85	0	1	4	1	H5521_085_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											705.42	30						667.86	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	86	0	1	4	1	H5521_086_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	86	0	1	4	1	H5521_086_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	86	0	1	4	1	H5521_086_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	86	0	1	4	1	H5521_086_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	86	0	1	4	1	H5521_086_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	86	0	1	4	1	H5521_086_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	86	0	1	4	1	H5521_086_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											786.53	33						749.48	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	87	0	1	4	1	H5521_087_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	87	0	1	4	1	H5521_087_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	87	0	1	4	1	H5521_087_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	87	0	1	4	1	H5521_087_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	87	0	1	4	1	H5521_087_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	87	0	1	4	1	H5521_087_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	87	0	1	4	1	H5521_087_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											748.28	30						704.13	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	88	0	1	4	1	H5521_088_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	88	0	1	4	1	H5521_088_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	88	0	1	4	1	H5521_088_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	88	0	1	4	1	H5521_088_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	88	0	1	4	1	H5521_088_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	88	0	1	4	1	H5521_088_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	88	0	1	4	1	H5521_088_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											814.29	30						818.71	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	89	0	1	4	1	H5521_089_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	89	0	1	4	1	H5521_089_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	89	0	1	4	1	H5521_089_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	89	0	1	4	1	H5521_089_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	89	0	1	4	1	H5521_089_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	89	0	1	4	1	H5521_089_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	89	0	1	4	1	H5521_089_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											692.21	30						679.37	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	90	0	1	4	1	H5521_090_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	90	0	1	4	1	H5521_090_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	90	0	1	4	1	H5521_090_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	90	0	1	4	1	H5521_090_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	90	0	1	4	1	H5521_090_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	90	0	1	4	1	H5521_090_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	90	0	1	4	1	H5521_090_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											708.39	30						677.08	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	91	0	1	4	1	H5521_091_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	91	0	1	4	1	H5521_091_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	91	0	1	4	1	H5521_091_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	91	0	1	4	1	H5521_091_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	91	0	1	4	1	H5521_091_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	91	0	1	4	1	H5521_091_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	91	0	1	4	1	H5521_091_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											716.65	29						752.86	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	95	0	1	4	1	H5521_095_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	95	0	1	4	1	H5521_095_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	95	0	1	4	1	H5521_095_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	95	0	1	4	1	H5521_095_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	95	0	1	4	1	H5521_095_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	95	0	1	4	1	H5521_095_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	95	0	1	4	1	H5521_095_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											673.7	33						616.47	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	99	0	1	4	1	H5521_099_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	99	0	1	4	1	H5521_099_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	99	0	1	4	1	H5521_099_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	99	0	1	4	1	H5521_099_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	99	0	1	4	1	H5521_099_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	99	0	1	4	1	H5521_099_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	99	0	1	4	1	H5521_099_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											639.85	33						630.99	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	100	0	1	4	1	H5521_100_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	100	0	1	4	1	H5521_100_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	100	0	1	4	1	H5521_100_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			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	4	1	H5521_100_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			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	4	1	H5521_100_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	100	0	1	4	1	H5521_100_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	100	0	1	4	1	H5521_100_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											620.29	28						584.25	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	101	0	1	4	1	H5521_101_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	101	0	1	4	1	H5521_101_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	101	0	1	4	1	H5521_101_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	101	0	1	4	1	H5521_101_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	101	0	1	4	1	H5521_101_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	101	0	1	4	1	H5521_101_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	101	0	1	4	1	H5521_101_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											588.61	31						586.39	31												31						31						31		31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	102	0	1	4	1	H5521_102_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	102	0	1	4	1	H5521_102_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	102	0	1	4	1	H5521_102_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	102	0	1	4	1	H5521_102_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	102	0	1	4	1	H5521_102_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	102	0	1	4	1	H5521_102_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	102	0	1	4	1	H5521_102_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											757.07	33						701.41	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	110	0	1	4	1	H5521_110_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	110	0	1	4	1	H5521_110_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	110	0	1	4	1	H5521_110_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	110	0	1	4	1	H5521_110_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	110	0	1	4	1	H5521_110_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	110	0	1	4	1	H5521_110_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	110	0	1	4	1	H5521_110_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											611.78	29						568.05	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	116	0	1	4	1	H5521_116_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	116	0	1	4	1	H5521_116_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	116	0	1	4	1	H5521_116_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_116_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_116_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	116	0	1	4	1	H5521_116_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	116	0	1	4	1	H5521_116_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											657.95	30						608.85	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	117	0	1	4	1	H5521_117_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	117	0	1	4	1	H5521_117_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	117	0	1	4	1	H5521_117_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			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	4	1	H5521_117_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			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	4	1	H5521_117_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	117	0	1	4	1	H5521_117_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	117	0	1	4	1	H5521_117_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											557.09	27						512.39	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	118	0	1	4	1	H5521_118_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	118	0	1	4	1	H5521_118_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	118	0	1	4	1	H5521_118_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	118	0	1	4	1	H5521_118_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	118	0	1	4	1	H5521_118_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	118	0	1	4	1	H5521_118_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	118	0	1	4	1	H5521_118_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											587.23	26						592.54	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	119	0	1	4	1	H5521_119_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	119	0	1	4	1	H5521_119_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	119	0	1	4	1	H5521_119_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	119	0	1	4	1	H5521_119_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	119	0	1	4	1	H5521_119_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	119	0	1	4	1	H5521_119_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	119	0	1	4	1	H5521_119_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											745.69	29						689.41	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	120	0	1	4	1	H5521_120_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	120	0	1	4	1	H5521_120_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	120	0	1	4	1	H5521_120_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_120_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_120_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	120	0	1	4	1	H5521_120_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	120	0	1	4	1	H5521_120_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											640.84	27						608.5	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	121	0	1	4	1	H5521_121_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	121	0	1	4	1	H5521_121_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	121	0	1	4	1	H5521_121_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	121	0	1	4	1	H5521_121_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	121	0	1	4	1	H5521_121_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	121	0	1	4	1	H5521_121_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	121	0	1	4	1	H5521_121_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											529.2	28						484.62	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	122	0	1	4	1	H5521_122_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	122	0	1	4	1	H5521_122_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	122	0	1	4	1	H5521_122_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_122_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_122_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	122	0	1	4	1	H5521_122_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	122	0	1	4	1	H5521_122_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											688.56	33						651.68	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	123	0	1	4	1	H5521_123_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	123	0	1	4	1	H5521_123_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	123	0	1	4	1	H5521_123_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			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	4	1	H5521_123_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			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	4	1	H5521_123_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	123	0	1	4	1	H5521_123_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	123	0	1	4	1	H5521_123_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											662.41	28						640.24	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	124	0	1	4	1	H5521_124_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	124	0	1	4	1	H5521_124_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	124	0	1	4	1	H5521_124_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	124	0	1	4	1	H5521_124_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	124	0	1	4	1	H5521_124_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	124	0	1	4	1	H5521_124_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	124	0	1	4	1	H5521_124_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											747.3	29						724.02	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	125	0	1	4	1	H5521_125_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	125	0	1	4	1	H5521_125_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	125	0	1	4	1	H5521_125_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	125	0	1	4	1	H5521_125_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	125	0	1	4	1	H5521_125_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	125	0	1	4	1	H5521_125_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	125	0	1	4	1	H5521_125_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											669.23	33						646.98	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	127	0	1	4	1	H5521_127_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	127	0	1	4	1	H5521_127_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	127	0	1	4	1	H5521_127_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	127	0	1	4	1	H5521_127_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	127	0	1	4	1	H5521_127_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	127	0	1	4	1	H5521_127_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	127	0	1	4	1	H5521_127_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											798.85	33						786.2	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	128	0	1	4	1	H5521_128_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	128	0	1	4	1	H5521_128_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	128	0	1	4	1	H5521_128_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	128	0	1	4	1	H5521_128_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	128	0	1	4	1	H5521_128_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	128	0	1	4	1	H5521_128_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	128	0	1	4	1	H5521_128_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											620.84	33						586.14	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	134	0	1	4	1	H5521_134_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	134	0	1	4	1	H5521_134_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	134	0	1	4	1	H5521_134_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	134	0	1	4	1	H5521_134_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	134	0	1	4	1	H5521_134_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	134	0	1	4	1	H5521_134_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	134	0	1	4	1	H5521_134_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											659.41	33						637.43	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	139	0	1	4	1	H5521_139_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	139	0	1	4	1	H5521_139_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	139	0	1	4	1	H5521_139_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_139_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_139_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	139	0	1	4	1	H5521_139_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	139	0	1	4	1	H5521_139_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											808.77	30						765.43	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	140	0	1	4	1	H5521_140_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	140	0	1	4	1	H5521_140_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	140	0	1	4	1	H5521_140_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	140	0	1	4	1	H5521_140_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	140	0	1	4	1	H5521_140_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	140	0	1	4	1	H5521_140_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	140	0	1	4	1	H5521_140_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											657.5	28						646.65	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	141	0	1	4	1	H5521_141_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	141	0	1	4	1	H5521_141_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	141	0	1	4	1	H5521_141_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	141	0	1	4	1	H5521_141_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	141	0	1	4	1	H5521_141_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	141	0	1	4	1	H5521_141_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	141	0	1	4	1	H5521_141_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											532.12	33						495.4	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	142	0	1	4	1	H5521_142_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	142	0	1	4	1	H5521_142_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	142	0	1	4	1	H5521_142_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	142	0	1	4	1	H5521_142_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	142	0	1	4	1	H5521_142_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	142	0	1	4	1	H5521_142_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	142	0	1	4	1	H5521_142_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											754.7	28						721.01	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	143	0	1	4	1	H5521_143_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	143	0	1	4	1	H5521_143_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	143	0	1	4	1	H5521_143_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_143_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_143_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	143	0	1	4	1	H5521_143_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	143	0	1	4	1	H5521_143_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											757.98	33						715.29	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	144	0	1	4	1	H5521_144_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	144	0	1	4	1	H5521_144_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	144	0	1	4	1	H5521_144_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_144_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			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	4	1	H5521_144_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	144	0	1	4	1	H5521_144_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	144	0	1	4	1	H5521_144_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											711.58	30						672.19	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	150	0	1	4	1	H5521_150_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	150	0	1	4	1	H5521_150_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	150	0	1	4	1	H5521_150_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	150	0	1	4	1	H5521_150_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	150	0	1	4	1	H5521_150_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	150	0	1	4	1	H5521_150_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	150	0	1	4	1	H5521_150_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											735.63	29						685.24	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	154	0	1	4	1	H5521_154_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	154	0	1	4	1	H5521_154_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	154	0	1	4	1	H5521_154_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	154	0	1	4	1	H5521_154_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	154	0	1	4	1	H5521_154_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	154	0	1	4	1	H5521_154_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	154	0	1	4	1	H5521_154_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											577.4	28						529.94	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	156	0	1	4	1	H5521_156_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	156	0	1	4	1	H5521_156_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	156	0	1	4	1	H5521_156_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	156	0	1	4	1	H5521_156_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	156	0	1	4	1	H5521_156_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	156	0	1	4	1	H5521_156_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	156	0	1	4	1	H5521_156_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											716.12	33						673.23	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	157	0	1	4	1	H5521_157_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	157	0	1	4	1	H5521_157_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	157	0	1	4	1	H5521_157_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	157	0	1	4	1	H5521_157_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	157	0	1	4	1	H5521_157_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	157	0	1	4	1	H5521_157_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	157	0	1	4	1	H5521_157_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											861.3	33						830.7	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	159	0	1	4	1	H5521_159_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	159	0	1	4	1	H5521_159_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	159	0	1	4	1	H5521_159_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	159	0	1	4	1	H5521_159_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	159	0	1	4	1	H5521_159_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	159	0	1	4	1	H5521_159_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	159	0	1	4	1	H5521_159_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											682.04	28						653.23	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	160	0	1	4	1	H5521_160_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	160	0	1	4	1	H5521_160_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	160	0	1	4	1	H5521_160_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	160	0	1	4	1	H5521_160_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	160	0	1	4	1	H5521_160_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	160	0	1	4	1	H5521_160_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	160	0	1	4	1	H5521_160_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											665.42	27						630.49	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	168	0	1	4	1	H5521_168_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	168	0	1	4	1	H5521_168_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	168	0	1	4	1	H5521_168_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	168	0	1	4	1	H5521_168_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	168	0	1	4	1	H5521_168_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	168	0	1	4	1	H5521_168_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	168	0	1	4	1	H5521_168_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											709.81	29						673.83	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	169	0	1	4	1	H5521_169_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	169	0	1	4	1	H5521_169_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	169	0	1	4	1	H5521_169_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	169	0	1	4	1	H5521_169_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	169	0	1	4	1	H5521_169_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	169	0	1	4	1	H5521_169_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	169	0	1	4	1	H5521_169_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											709.83	29						662.69	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	170	0	1	4	1	H5521_170_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	170	0	1	4	1	H5521_170_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	170	0	1	4	1	H5521_170_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	170	0	1	4	1	H5521_170_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	170	0	1	4	1	H5521_170_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	170	0	1	4	1	H5521_170_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	170	0	1	4	1	H5521_170_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											766.79	28						715.31	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	171	0	1	4	1	H5521_171_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	171	0	1	4	1	H5521_171_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	171	0	1	4	1	H5521_171_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	171	0	1	4	1	H5521_171_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	171	0	1	4	1	H5521_171_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	171	0	1	4	1	H5521_171_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	171	0	1	4	1	H5521_171_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											668.48	29						633.62	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	177	0	1	4	1	H5521_177_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	177	0	1	4	1	H5521_177_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	177	0	1	4	1	H5521_177_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	177	0	1	4	1	H5521_177_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	177	0	1	4	1	H5521_177_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	177	0	1	4	1	H5521_177_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	177	0	1	4	1	H5521_177_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											811.03	29						789.54	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	178	0	1	4	1	H5521_178_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	178	0	1	4	1	H5521_178_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	178	0	1	4	1	H5521_178_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	178	0	1	4	1	H5521_178_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	178	0	1	4	1	H5521_178_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	178	0	1	4	1	H5521_178_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	178	0	1	4	1	H5521_178_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											715.66	31						676.02	31												31						31						31		31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	183	0	1	4	1	H5521_183_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	183	0	1	4	1	H5521_183_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	183	0	1	4	1	H5521_183_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	183	0	1	4	1	H5521_183_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	183	0	1	4	1	H5521_183_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	183	0	1	4	1	H5521_183_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	183	0	1	4	1	H5521_183_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											776.56	33						743.6	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	184	0	1	4	1	H5521_184_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	184	0	1	4	1	H5521_184_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	184	0	1	4	1	H5521_184_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	184	0	1	4	1	H5521_184_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	184	0	1	4	1	H5521_184_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	184	0	1	4	1	H5521_184_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	184	0	1	4	1	H5521_184_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											571.33	33						542.8	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	187	0	1	4	1	H5521_187_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	187	0	1	4	1	H5521_187_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	187	0	1	4	1	H5521_187_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	187	0	1	4	1	H5521_187_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	187	0	1	4	1	H5521_187_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	187	0	1	4	1	H5521_187_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	187	0	1	4	1	H5521_187_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											543.23	33						494.15	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	190	0	1	4	1	H5521_190_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	190	0	1	4	1	H5521_190_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	190	0	1	4	1	H5521_190_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	190	0	1	4	1	H5521_190_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	190	0	1	4	1	H5521_190_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	190	0	1	4	1	H5521_190_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	190	0	1	4	1	H5521_190_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											821.59	33						819.56	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	194	0	1	4	1	H5521_194_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	194	0	1	4	1	H5521_194_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	194	0	1	4	1	H5521_194_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	194	0	1	4	1	H5521_194_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	194	0	1	4	1	H5521_194_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	194	0	1	4	1	H5521_194_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	194	0	1	4	1	H5521_194_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											734.37	33						664.48	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	195	0	1	4	1	H5521_195_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	195	0	1	4	1	H5521_195_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	195	0	1	4	1	H5521_195_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	195	0	1	4	1	H5521_195_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	195	0	1	4	1	H5521_195_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	195	0	1	4	1	H5521_195_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	195	0	1	4	1	H5521_195_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											600	29						572.16	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	196	0	1	4	1	H5521_196_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	196	0	1	4	1	H5521_196_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	196	0	1	4	1	H5521_196_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	196	0	1	4	1	H5521_196_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	196	0	1	4	1	H5521_196_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	196	0	1	4	1	H5521_196_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	196	0	1	4	1	H5521_196_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											684.07	27						643.95	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	197	0	1	4	1	H5521_197_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	197	0	1	4	1	H5521_197_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	197	0	1	4	1	H5521_197_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	197	0	1	4	1	H5521_197_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	197	0	1	4	1	H5521_197_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	197	0	1	4	1	H5521_197_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	197	0	1	4	1	H5521_197_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											637.58	31						599.13	31												31						31						31		31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	200	0	1	4	1	H5521_200_0	3	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	200	0	1	4	1	H5521_200_0	3	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	200	0	1	4	1	H5521_200_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	200	0	1	4	1	H5521_200_0	3	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	200	0	1	4	1	H5521_200_0	3	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											640	27						600.42	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	205	0	1	4	1	H5521_205_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	205	0	1	4	1	H5521_205_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	205	0	1	4	1	H5521_205_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	205	0	1	4	1	H5521_205_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	205	0	1	4	1	H5521_205_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	205	0	1	4	1	H5521_205_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	205	0	1	4	1	H5521_205_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											860.85	33						855.31	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	206	0	1	4	1	H5521_206_0	3	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	206	0	1	4	1	H5521_206_0	3	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	206	0	1	4	1	H5521_206_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	206	0	1	4	1	H5521_206_0	3	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	206	0	1	4	1	H5521_206_0	3	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											644.19	27						611.88	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	207	0	1	4	1	H5521_207_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	207	0	1	4	1	H5521_207_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	207	0	1	4	1	H5521_207_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	207	0	1	4	1	H5521_207_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	207	0	1	4	1	H5521_207_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	207	0	1	4	1	H5521_207_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	207	0	1	4	1	H5521_207_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											772.52	33						727.98	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	208	0	1	4	1	H5521_208_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	208	0	1	4	1	H5521_208_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	208	0	1	4	1	H5521_208_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	208	0	1	4	1	H5521_208_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	208	0	1	4	1	H5521_208_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	208	0	1	4	1	H5521_208_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	208	0	1	4	1	H5521_208_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											772.1	33						727.78	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	211	0	1	4	1	H5521_211_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	211	0	1	4	1	H5521_211_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	211	0	1	4	1	H5521_211_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	211	0	1	4	1	H5521_211_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	211	0	1	4	1	H5521_211_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	211	0	1	4	1	H5521_211_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	211	0	1	4	1	H5521_211_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											671.92	33						626.53	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	212	0	1	4	1	H5521_212_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	212	0	1	4	1	H5521_212_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	212	0	1	4	1	H5521_212_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	212	0	1	4	1	H5521_212_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	212	0	1	4	1	H5521_212_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	212	0	1	4	1	H5521_212_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	212	0	1	4	1	H5521_212_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											657.19	28						627.64	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	214	0	1	4	1	H5521_214_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	214	0	1	4	1	H5521_214_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	214	0	1	4	1	H5521_214_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	214	0	1	4	1	H5521_214_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	214	0	1	4	1	H5521_214_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	214	0	1	4	1	H5521_214_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	214	0	1	4	1	H5521_214_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											675.47	30						642.66	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	215	0	1	4	1	H5521_215_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	215	0	1	4	1	H5521_215_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	215	0	1	4	1	H5521_215_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	215	0	1	4	1	H5521_215_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	215	0	1	4	1	H5521_215_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	215	0	1	4	1	H5521_215_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	215	0	1	4	1	H5521_215_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											657.13	28						627.56	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	216	0	1	4	1	H5521_216_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	216	0	1	4	1	H5521_216_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	216	0	1	4	1	H5521_216_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	216	0	1	4	1	H5521_216_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	216	0	1	4	1	H5521_216_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	216	0	1	4	1	H5521_216_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	216	0	1	4	1	H5521_216_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											665.77	29						629.11	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	217	0	1	4	1	H5521_217_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	217	0	1	4	1	H5521_217_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	217	0	1	4	1	H5521_217_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	217	0	1	4	1	H5521_217_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	217	0	1	4	1	H5521_217_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	217	0	1	4	1	H5521_217_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	217	0	1	4	1	H5521_217_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											764.86	33						733.56	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	218	0	1	4	1	H5521_218_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	218	0	1	4	1	H5521_218_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	218	0	1	4	1	H5521_218_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	218	0	1	4	1	H5521_218_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	218	0	1	4	1	H5521_218_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	218	0	1	4	1	H5521_218_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	218	0	1	4	1	H5521_218_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											662.98	29						625.66	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	219	0	1	4	1	H5521_219_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	219	0	1	4	1	H5521_219_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	219	0	1	4	1	H5521_219_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	219	0	1	4	1	H5521_219_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	219	0	1	4	1	H5521_219_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	219	0	1	4	1	H5521_219_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	219	0	1	4	1	H5521_219_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											736.02	33						699.48	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	220	0	1	4	1	H5521_220_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	220	0	1	4	1	H5521_220_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	220	0	1	4	1	H5521_220_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	220	0	1	4	1	H5521_220_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	220	0	1	4	1	H5521_220_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	220	0	1	4	1	H5521_220_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	220	0	1	4	1	H5521_220_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											662.99	29						625.66	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	221	0	1	4	1	H5521_221_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	221	0	1	4	1	H5521_221_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	221	0	1	4	1	H5521_221_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	221	0	1	4	1	H5521_221_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	221	0	1	4	1	H5521_221_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	221	0	1	4	1	H5521_221_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	221	0	1	4	1	H5521_221_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											792.68	33						750.13	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	222	0	1	4	1	H5521_222_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	222	0	1	4	1	H5521_222_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	222	0	1	4	1	H5521_222_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	222	0	1	4	1	H5521_222_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	222	0	1	4	1	H5521_222_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	222	0	1	4	1	H5521_222_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	222	0	1	4	1	H5521_222_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											665.73	29						629.06	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	223	0	1	4	1	H5521_223_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	223	0	1	4	1	H5521_223_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	223	0	1	4	1	H5521_223_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	223	0	1	4	1	H5521_223_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	223	0	1	4	1	H5521_223_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	223	0	1	4	1	H5521_223_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	223	0	1	4	1	H5521_223_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											724.38	33						683.55	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	224	0	1	4	1	H5521_224_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	224	0	1	4	1	H5521_224_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	224	0	1	4	1	H5521_224_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	224	0	1	4	1	H5521_224_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	224	0	1	4	1	H5521_224_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	224	0	1	4	1	H5521_224_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	224	0	1	4	1	H5521_224_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											665.72	29						629.05	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	226	0	1	4	1	H5521_226_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	226	0	1	4	1	H5521_226_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	226	0	1	4	1	H5521_226_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	226	0	1	4	1	H5521_226_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	226	0	1	4	1	H5521_226_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	226	0	1	4	1	H5521_226_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	226	0	1	4	1	H5521_226_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											724.38	33						683.55	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	227	0	1	4	1	H5521_227_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	227	0	1	4	1	H5521_227_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	227	0	1	4	1	H5521_227_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	227	0	1	4	1	H5521_227_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	227	0	1	4	1	H5521_227_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	227	0	1	4	1	H5521_227_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	227	0	1	4	1	H5521_227_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											665.74	29						629.08	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	228	0	1	4	1	H5521_228_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	228	0	1	4	1	H5521_228_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	228	0	1	4	1	H5521_228_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	228	0	1	4	1	H5521_228_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	228	0	1	4	1	H5521_228_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	228	0	1	4	1	H5521_228_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	228	0	1	4	1	H5521_228_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											740.65	33						696.52	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	230	0	1	4	1	H5521_230_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	230	0	1	4	1	H5521_230_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	230	0	1	4	1	H5521_230_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	230	0	1	4	1	H5521_230_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	230	0	1	4	1	H5521_230_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	230	0	1	4	1	H5521_230_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	230	0	1	4	1	H5521_230_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											663.55	29						625.53	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	231	0	1	4	1	H5521_231_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	231	0	1	4	1	H5521_231_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	231	0	1	4	1	H5521_231_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	231	0	1	4	1	H5521_231_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	231	0	1	4	1	H5521_231_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	231	0	1	4	1	H5521_231_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	231	0	1	4	1	H5521_231_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											638.43	33						596.28	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	232	0	1	4	1	H5521_232_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	232	0	1	4	1	H5521_232_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	232	0	1	4	1	H5521_232_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	232	0	1	4	1	H5521_232_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	232	0	1	4	1	H5521_232_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	232	0	1	4	1	H5521_232_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	232	0	1	4	1	H5521_232_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											663.53	29						625.5	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	233	0	1	4	1	H5521_233_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	233	0	1	4	1	H5521_233_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	233	0	1	4	1	H5521_233_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	233	0	1	4	1	H5521_233_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	233	0	1	4	1	H5521_233_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	233	0	1	4	1	H5521_233_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	233	0	1	4	1	H5521_233_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											663.53	29						625.5	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	234	0	1	4	1	H5521_234_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	234	0	1	4	1	H5521_234_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	234	0	1	4	1	H5521_234_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	234	0	1	4	1	H5521_234_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	234	0	1	4	1	H5521_234_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	234	0	1	4	1	H5521_234_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	234	0	1	4	1	H5521_234_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											663.52	29						625.48	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	236	0	1	4	1	H5521_236_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	236	0	1	4	1	H5521_236_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	236	0	1	4	1	H5521_236_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	236	0	1	4	1	H5521_236_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	236	0	1	4	1	H5521_236_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	236	0	1	4	1	H5521_236_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	236	0	1	4	1	H5521_236_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											700.18	30						660.55	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	237	0	1	4	1	H5521_237_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	237	0	1	4	1	H5521_237_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	237	0	1	4	1	H5521_237_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	237	0	1	4	1	H5521_237_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	237	0	1	4	1	H5521_237_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	237	0	1	4	1	H5521_237_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	237	0	1	4	1	H5521_237_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											647.4	28						615.94	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	239	0	1	4	1	H5521_239_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	239	0	1	4	1	H5521_239_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	239	0	1	4	1	H5521_239_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	239	0	1	4	1	H5521_239_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	239	0	1	4	1	H5521_239_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	239	0	1	4	1	H5521_239_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	239	0	1	4	1	H5521_239_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											700.25	30						660.6	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	243	0	1	4	1	H5521_243_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	243	0	1	4	1	H5521_243_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	243	0	1	4	1	H5521_243_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	243	0	1	4	1	H5521_243_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	243	0	1	4	1	H5521_243_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	243	0	1	4	1	H5521_243_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	243	0	1	4	1	H5521_243_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											700.18	30						660.54	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	244	0	1	4	1	H5521_244_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	244	0	1	4	1	H5521_244_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	244	0	1	4	1	H5521_244_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	244	0	1	4	1	H5521_244_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	244	0	1	4	1	H5521_244_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	244	0	1	4	1	H5521_244_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	244	0	1	4	1	H5521_244_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											668.16	29						635.79	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	245	0	1	4	1	H5521_245_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	245	0	1	4	1	H5521_245_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	245	0	1	4	1	H5521_245_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	245	0	1	4	1	H5521_245_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	245	0	1	4	1	H5521_245_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	245	0	1	4	1	H5521_245_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	245	0	1	4	1	H5521_245_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											713.92	30						675.43	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	246	0	1	4	1	H5521_246_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	246	0	1	4	1	H5521_246_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	246	0	1	4	1	H5521_246_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	246	0	1	4	1	H5521_246_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	246	0	1	4	1	H5521_246_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	246	0	1	4	1	H5521_246_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	246	0	1	4	1	H5521_246_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											731.94	33						690.15	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	247	0	1	4	1	H5521_247_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	247	0	1	4	1	H5521_247_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	247	0	1	4	1	H5521_247_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	247	0	1	4	1	H5521_247_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	247	0	1	4	1	H5521_247_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	247	0	1	4	1	H5521_247_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	247	0	1	4	1	H5521_247_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											713.92	30						675.43	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	249	0	1	4	1	H5521_249_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	249	0	1	4	1	H5521_249_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	249	0	1	4	1	H5521_249_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	249	0	1	4	1	H5521_249_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	249	0	1	4	1	H5521_249_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	249	0	1	4	1	H5521_249_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	249	0	1	4	1	H5521_249_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											713.92	30						675.44	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	250	0	1	4	1	H5521_250_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	250	0	1	4	1	H5521_250_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	250	0	1	4	1	H5521_250_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	250	0	1	4	1	H5521_250_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	250	0	1	4	1	H5521_250_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	250	0	1	4	1	H5521_250_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	250	0	1	4	1	H5521_250_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											772.58	33						728.01	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	251	0	1	4	1	H5521_251_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	251	0	1	4	1	H5521_251_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	251	0	1	4	1	H5521_251_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	251	0	1	4	1	H5521_251_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	251	0	1	4	1	H5521_251_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	251	0	1	4	1	H5521_251_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	251	0	1	4	1	H5521_251_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											713.92	30						675.43	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	252	0	1	4	1	H5521_252_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	252	0	1	4	1	H5521_252_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	252	0	1	4	1	H5521_252_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	252	0	1	4	1	H5521_252_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	252	0	1	4	1	H5521_252_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	252	0	1	4	1	H5521_252_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	252	0	1	4	1	H5521_252_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											691.31	29						653.48	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	253	0	1	4	1	H5521_253_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	253	0	1	4	1	H5521_253_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	253	0	1	4	1	H5521_253_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	253	0	1	4	1	H5521_253_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	253	0	1	4	1	H5521_253_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	253	0	1	4	1	H5521_253_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	253	0	1	4	1	H5521_253_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											778.8	33						736.22	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	254	0	1	4	1	H5521_254_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	254	0	1	4	1	H5521_254_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	254	0	1	4	1	H5521_254_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	254	0	1	4	1	H5521_254_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	254	0	1	4	1	H5521_254_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	254	0	1	4	1	H5521_254_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	254	0	1	4	1	H5521_254_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											644.94	28						609.52	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	259	0	1	4	1	H5521_259_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	259	0	1	4	1	H5521_259_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	259	0	1	4	1	H5521_259_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	259	0	1	4	1	H5521_259_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	259	0	1	4	1	H5521_259_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	259	0	1	4	1	H5521_259_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	259	0	1	4	1	H5521_259_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.82	30						625.99	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	260	0	1	4	1	H5521_260_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	260	0	1	4	1	H5521_260_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	260	0	1	4	1	H5521_260_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	260	0	1	4	1	H5521_260_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	260	0	1	4	1	H5521_260_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	260	0	1	4	1	H5521_260_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	260	0	1	4	1	H5521_260_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.84	30						626	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	261	0	1	4	1	H5521_261_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	261	0	1	4	1	H5521_261_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	261	0	1	4	1	H5521_261_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	261	0	1	4	1	H5521_261_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	261	0	1	4	1	H5521_261_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	261	0	1	4	1	H5521_261_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	261	0	1	4	1	H5521_261_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											771.7	33						728.55	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	262	0	1	4	1	H5521_262_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	262	0	1	4	1	H5521_262_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	262	0	1	4	1	H5521_262_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	262	0	1	4	1	H5521_262_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	262	0	1	4	1	H5521_262_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	262	0	1	4	1	H5521_262_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	262	0	1	4	1	H5521_262_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											761.55	33						720.4	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	263	0	1	4	1	H5521_263_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	263	0	1	4	1	H5521_263_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	263	0	1	4	1	H5521_263_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	263	0	1	4	1	H5521_263_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	263	0	1	4	1	H5521_263_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	263	0	1	4	1	H5521_263_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	263	0	1	4	1	H5521_263_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											771.69	33						728.56	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	266	0	1	4	1	H5521_266_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	266	0	1	4	1	H5521_266_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	266	0	1	4	1	H5521_266_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	266	0	1	4	1	H5521_266_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	266	0	1	4	1	H5521_266_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	266	0	1	4	1	H5521_266_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	266	0	1	4	1	H5521_266_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											721.64	33						682.38	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	267	0	1	4	1	H5521_267_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	267	0	1	4	1	H5521_267_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	267	0	1	4	1	H5521_267_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	267	0	1	4	1	H5521_267_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	267	0	1	4	1	H5521_267_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	267	0	1	4	1	H5521_267_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	267	0	1	4	1	H5521_267_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											661.77	30						625.96	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	268	0	1	4	1	H5521_268_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	268	0	1	4	1	H5521_268_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	268	0	1	4	1	H5521_268_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	268	0	1	4	1	H5521_268_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	268	0	1	4	1	H5521_268_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	268	0	1	4	1	H5521_268_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	268	0	1	4	1	H5521_268_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											710.33	30						666.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	269	0	1	4	1	H5521_269_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	269	0	1	4	1	H5521_269_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	269	0	1	4	1	H5521_269_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	269	0	1	4	1	H5521_269_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	269	0	1	4	1	H5521_269_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	269	0	1	4	1	H5521_269_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	269	0	1	4	1	H5521_269_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											710.34	30						666.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	270	0	1	4	1	H5521_270_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	270	0	1	4	1	H5521_270_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	270	0	1	4	1	H5521_270_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	270	0	1	4	1	H5521_270_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	270	0	1	4	1	H5521_270_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	270	0	1	4	1	H5521_270_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	270	0	1	4	1	H5521_270_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											710.34	30						666.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	271	0	1	4	1	H5521_271_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	271	0	1	4	1	H5521_271_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	271	0	1	4	1	H5521_271_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	271	0	1	4	1	H5521_271_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	271	0	1	4	1	H5521_271_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	271	0	1	4	1	H5521_271_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	271	0	1	4	1	H5521_271_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											710.34	30						666.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	272	0	1	4	1	H5521_272_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	272	0	1	4	1	H5521_272_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	272	0	1	4	1	H5521_272_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	272	0	1	4	1	H5521_272_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	272	0	1	4	1	H5521_272_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	272	0	1	4	1	H5521_272_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	272	0	1	4	1	H5521_272_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											710.34	30						666.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	273	0	1	4	1	H5521_273_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	273	0	1	4	1	H5521_273_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	273	0	1	4	1	H5521_273_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	273	0	1	4	1	H5521_273_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	273	0	1	4	1	H5521_273_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	273	0	1	4	1	H5521_273_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	273	0	1	4	1	H5521_273_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											710.34	30						666.01	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	275	0	1	4	1	H5521_275_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	275	0	1	4	1	H5521_275_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	275	0	1	4	1	H5521_275_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	275	0	1	4	1	H5521_275_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	275	0	1	4	1	H5521_275_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	275	0	1	4	1	H5521_275_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	275	0	1	4	1	H5521_275_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											688.14	29						654.14	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	276	0	1	4	1	H5521_276_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	276	0	1	4	1	H5521_276_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	276	0	1	4	1	H5521_276_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	276	0	1	4	1	H5521_276_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	276	0	1	4	1	H5521_276_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	276	0	1	4	1	H5521_276_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	276	0	1	4	1	H5521_276_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											688.13	29						654.12	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	277	0	1	4	1	H5521_277_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	277	0	1	4	1	H5521_277_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	277	0	1	4	1	H5521_277_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	277	0	1	4	1	H5521_277_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	277	0	1	4	1	H5521_277_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	277	0	1	4	1	H5521_277_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	277	0	1	4	1	H5521_277_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											688.19	29						654.2	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	278	0	1	4	1	H5521_278_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	278	0	1	4	1	H5521_278_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	278	0	1	4	1	H5521_278_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	278	0	1	4	1	H5521_278_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	278	0	1	4	1	H5521_278_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	278	0	1	4	1	H5521_278_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	278	0	1	4	1	H5521_278_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											623.07	26						592.15	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	280	0	1	4	1	H5521_280_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	280	0	1	4	1	H5521_280_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	280	0	1	4	1	H5521_280_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	280	0	1	4	1	H5521_280_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	280	0	1	4	1	H5521_280_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	280	0	1	4	1	H5521_280_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	280	0	1	4	1	H5521_280_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											750.6	33						709.44	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	281	0	1	4	1	H5521_281_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	281	0	1	4	1	H5521_281_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	281	0	1	4	1	H5521_281_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	281	0	1	4	1	H5521_281_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	281	0	1	4	1	H5521_281_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	281	0	1	4	1	H5521_281_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	281	0	1	4	1	H5521_281_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											750.68	33						709.54	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	282	0	1	4	1	H5521_282_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	282	0	1	4	1	H5521_282_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	282	0	1	4	1	H5521_282_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	282	0	1	4	1	H5521_282_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	282	0	1	4	1	H5521_282_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	282	0	1	4	1	H5521_282_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	282	0	1	4	1	H5521_282_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											742.02	33						698.99	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	283	0	1	4	1	H5521_283_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	283	0	1	4	1	H5521_283_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	283	0	1	4	1	H5521_283_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	283	0	1	4	1	H5521_283_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	283	0	1	4	1	H5521_283_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	283	0	1	4	1	H5521_283_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	283	0	1	4	1	H5521_283_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											741.96	33						698.97	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	284	0	1	4	1	H5521_284_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	284	0	1	4	1	H5521_284_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	284	0	1	4	1	H5521_284_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	284	0	1	4	1	H5521_284_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	284	0	1	4	1	H5521_284_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	284	0	1	4	1	H5521_284_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	284	0	1	4	1	H5521_284_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											736	33						699.4	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	285	0	1	4	1	H5521_285_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	285	0	1	4	1	H5521_285_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	285	0	1	4	1	H5521_285_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	285	0	1	4	1	H5521_285_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	285	0	1	4	1	H5521_285_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	285	0	1	4	1	H5521_285_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	285	0	1	4	1	H5521_285_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											736.15	33						699.73	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	288	0	1	4	1	H5521_288_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	288	0	1	4	1	H5521_288_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	288	0	1	4	1	H5521_288_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	288	0	1	4	1	H5521_288_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	288	0	1	4	1	H5521_288_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	288	0	1	4	1	H5521_288_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	288	0	1	4	1	H5521_288_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											748.38	33						711.44	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	289	0	1	4	1	H5521_289_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	289	0	1	4	1	H5521_289_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	289	0	1	4	1	H5521_289_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	289	0	1	4	1	H5521_289_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5521	289	0	1	4	1	H5521_289_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	289	0	1	4	1	H5521_289_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5521	289	0	1	4	1	H5521_289_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											659.8	29						622.09	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	1	0	1	4	1	H5522_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	1	0	1	4	1	H5522_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	1	0	1	4	1	H5522_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	1	0	1	4	1	H5522_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	1	0	1	4	1	H5522_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	1	0	1	4	1	H5522_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	1	0	1	4	1	H5522_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											827.27	33						869.88	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	2	0	1	4	1	H5522_002_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	2	0	1	4	1	H5522_002_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	2	0	1	4	1	H5522_002_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	2	0	1	4	1	H5522_002_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	2	0	1	4	1	H5522_002_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	2	0	1	4	1	H5522_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	2	0	1	4	1	H5522_002_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											856.81	33						826.7	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	4	0	1	4	1	H5522_004_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	4	0	1	4	1	H5522_004_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	4	0	1	4	1	H5522_004_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	4	0	1	4	1	H5522_004_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	4	0	1	4	1	H5522_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	4	0	1	4	1	H5522_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	4	0	1	4	1	H5522_004_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											721.63	33						689.78	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	5	0	1	4	1	H5522_005_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	5	0	1	4	1	H5522_005_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	5	0	1	4	1	H5522_005_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	5	0	1	4	1	H5522_005_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	5	0	1	4	1	H5522_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	5	0	1	4	1	H5522_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	5	0	1	4	1	H5522_005_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											863.36	33						868.23	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	13	0	1	4	1	H5522_013_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	13	0	1	4	1	H5522_013_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	13	0	1	4	1	H5522_013_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	13	0	1	4	1	H5522_013_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	13	0	1	4	1	H5522_013_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	13	0	1	4	1	H5522_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	13	0	1	4	1	H5522_013_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											841.84	33						947.3	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	14	0	1	4	1	H5522_014_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	14	0	1	4	1	H5522_014_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	14	0	1	4	1	H5522_014_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	14	0	1	4	1	H5522_014_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	14	0	1	4	1	H5522_014_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	14	0	1	4	1	H5522_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	14	0	1	4	1	H5522_014_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											945.86	33						889.01	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	17	0	1	4	1	H5522_017_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	17	0	1	4	1	H5522_017_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					3	6	0											15	30	45				3	6	0					15			15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	17	0	1	4	1	H5522_017_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	17	0	1	4	1	H5522_017_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					7	14	14											20	40	60				7	14	14					20			20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	17	0	1	4	1	H5522_017_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	17	0	1	4	1	H5522_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	17	0	1	4	1	H5522_017_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											645.16	28						647.63	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	18	0	1	4	1	H5522_018_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	18	0	1	4	1	H5522_018_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	18	0	1	4	1	H5522_018_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	18	0	1	4	1	H5522_018_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5522	18	0	1	4	1	H5522_018_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	18	0	1	4	1	H5522_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5522	18	0	1	4	1	H5522_018_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											812.14	33						785.94	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5525	4	0	1	4	1	H5525_004_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	4	0	1	4	1	H5525_004_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	4	0	1	4	1	H5525_004_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	4	0	1	4	1	H5525_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	4	0	1	4	1	H5525_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	5	0	1	4	1	H5525_005_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	5	0	1	4	1	H5525_005_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	5	0	1	4	1	H5525_005_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	5	0	1	4	1	H5525_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	5	0	1	4	1	H5525_005_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	6	0	1	4	1	H5525_006_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	6	0	1	4	1	H5525_006_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	6	0	1	4	1	H5525_006_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	6	0	1	4	1	H5525_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	6	0	1	4	1	H5525_006_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	7	0	1	4	1	H5525_007_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	7	0	1	4	1	H5525_007_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	7	0	1	4	1	H5525_007_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	7	0	1	4	1	H5525_007_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	7	0	1	4	1	H5525_007_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	8	0	1	4	1	H5525_008_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	8	0	1	4	1	H5525_008_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	8	0	1	4	1	H5525_008_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	8	0	1	4	1	H5525_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	8	0	1	4	1	H5525_008_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	15	0	1	4	1	H5525_015_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	15	0	1	4	1	H5525_015_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	15	0	1	4	1	H5525_015_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	15	0	1	4	1	H5525_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	15	0	1	4	1	H5525_015_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	17	0	1	4	1	H5525_017_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	17	0	1	4	1	H5525_017_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	17	0	1	4	1	H5525_017_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	17	0	1	4	1	H5525_017_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	17	0	1	4	1	H5525_017_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	20	0	1	4	1	H5525_020_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	20	0	1	4	1	H5525_020_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	20	0	1	4	1	H5525_020_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	20	0	1	4	1	H5525_020_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	20	0	1	4	1	H5525_020_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	22	0	1	4	1	H5525_022_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	22	0	1	4	1	H5525_022_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	22	0	1	4	1	H5525_022_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	22	0	1	4	1	H5525_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	22	0	1	4	1	H5525_022_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	23	0	1	4	1	H5525_023_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	23	0	1	4	1	H5525_023_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	23	0	1	4	1	H5525_023_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	23	0	1	4	1	H5525_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	23	0	1	4	1	H5525_023_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	24	0	1	4	1	H5525_024_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	24	0	1	4	1	H5525_024_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	24	0	1	4	1	H5525_024_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	24	0	1	4	1	H5525_024_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	24	0	1	4	1	H5525_024_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	25	0	1	4	1	H5525_025_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	25	0	1	4	1	H5525_025_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	25	0	1	4	1	H5525_025_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	25	0	1	4	1	H5525_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	25	0	1	4	1	H5525_025_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	26	0	1	4	1	H5525_026_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	26	0	1	4	1	H5525_026_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	26	0	1	4	1	H5525_026_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	26	0	1	4	1	H5525_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	26	0	1	4	1	H5525_026_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	27	0	1	4	1	H5525_027_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	27	0	1	4	1	H5525_027_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	27	0	1	4	1	H5525_027_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	27	0	1	4	1	H5525_027_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											67	50		50				67	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	27	0	1	4	1	H5525_027_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	30	0	1	4	1	H5525_030_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	30	0	1	4	1	H5525_030_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	30	0	1	4	1	H5525_030_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	30	0	1	4	1	H5525_030_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	30	0	1	4	1	H5525_030_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	34	0	1	4	1	H5525_034_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	34	0	1	4	1	H5525_034_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	34	0	1	4	1	H5525_034_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	34	0	1	4	1	H5525_034_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	34	0	1	4	1	H5525_034_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	35	0	1	4	1	H5525_035_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	35	0	1	4	1	H5525_035_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	35	0	1	4	1	H5525_035_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	35	0	1	4	1	H5525_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	35	0	1	4	1	H5525_035_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	36	0	1	4	1	H5525_036_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	36	0	1	4	1	H5525_036_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	36	0	1	4	1	H5525_036_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	36	0	1	4	1	H5525_036_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	36	0	1	4	1	H5525_036_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	37	0	1	4	1	H5525_037_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	37	0	1	4	1	H5525_037_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	37	0	1	4	1	H5525_037_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	37	0	1	4	1	H5525_037_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	37	0	1	4	1	H5525_037_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	38	0	1	4	1	H5525_038_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	38	0	1	4	1	H5525_038_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	38	0	1	4	1	H5525_038_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	38	0	1	4	1	H5525_038_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	38	0	1	4	1	H5525_038_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	39	0	1	4	1	H5525_039_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	39	0	1	4	1	H5525_039_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	39	0	1	4	1	H5525_039_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	39	0	1	4	1	H5525_039_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	39	0	1	4	1	H5525_039_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	40	0	1	4	1	H5525_040_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	40	0	1	4	1	H5525_040_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	40	0	1	4	1	H5525_040_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	40	0	1	4	1	H5525_040_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	40	0	1	4	1	H5525_040_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	41	0	1	4	1	H5525_041_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	41	0	1	4	1	H5525_041_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	41	0	1	4	1	H5525_041_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	41	0	1	4	1	H5525_041_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	41	0	1	4	1	H5525_041_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	42	0	1	4	1	H5525_042_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	42	0	1	4	1	H5525_042_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	42	0	1	4	1	H5525_042_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	42	0	1	4	1	H5525_042_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	42	0	1	4	1	H5525_042_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	44	0	1	4	1	H5525_044_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	44	0	1	4	1	H5525_044_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	44	0	1	4	1	H5525_044_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	44	0	1	4	1	H5525_044_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	44	0	1	4	1	H5525_044_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	45	0	1	4	1	H5525_045_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	45	0	1	4	1	H5525_045_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	45	0	1	4	1	H5525_045_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	45	0	1	4	1	H5525_045_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	45	0	1	4	1	H5525_045_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	46	0	1	4	1	H5525_046_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	46	0	1	4	1	H5525_046_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	46	0	1	4	1	H5525_046_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	46	0	1	4	1	H5525_046_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	46	0	1	4	1	H5525_046_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	47	0	1	4	1	H5525_047_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	47	0	1	4	1	H5525_047_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	47	0	1	4	1	H5525_047_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	47	0	1	4	1	H5525_047_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5525	47	0	1	4	1	H5525_047_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	4	0	1	4	1	H5526_004_0	5	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								7		21					2		6					2		0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	4	0	1	4	1	H5526_004_0	5	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								13		39					8		24					8		20																13				13			0.43	0.27	0.27			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	4	0	1	4	1	H5526_004_0	5	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	4	0	1	4	1	H5526_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								99		297					94		282					94		235																99				99			3.3	3.13	3.13			3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	4	0	1	4	1	H5526_004_0	5	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	16	0	1	4	1	H5526_016_0	6	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								9		27					4		12					4		0																9				9			0.3	0.13	0.13			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	16	0	1	4	1	H5526_016_0	6	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					10		30					10		25																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	16	0	1	4	1	H5526_016_0	6	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	16	0	1	4	1	H5526_016_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	16	0	1	4	1	H5526_016_0	6	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	18	0	1	4	1	H5526_018_0	5	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								7		21					2		6					2		0																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	18	0	1	4	1	H5526_018_0	5	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								17		51					12		36					12		30																17				17			0.57	0.4	0.4			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	18	0	1	4	1	H5526_018_0	5	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					42		126					42		105																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	18	0	1	4	1	H5526_018_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					94		282					94		235																100				100			3.33	3.13	3.13			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5526	18	0	1	4	1	H5526_018_0	5	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	3	0	1	4	1	H5533_003_0	12	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	3	0	1	4	1	H5533_003_0	12	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	3	0	1	4	1	H5533_003_0	12	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	3	0	1	4	1	H5533_003_0	12	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	3	0	1	4	1	H5533_003_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											819.58	33						624.2	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	5	0	1	4	1	H5533_005_0	12	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	5	0	1	4	1	H5533_005_0	12	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	5	0	1	4	1	H5533_005_0	12	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	5	0	1	4	1	H5533_005_0	12	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	5	0	1	4	1	H5533_005_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1512.26	33						920.68	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	7	0	1	4	1	H5533_007_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	7	0	1	4	1	H5533_007_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	7	0	1	4	1	H5533_007_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	7	0	1	4	1	H5533_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	7	0	1	4	1	H5533_007_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											795.05	33						650.66	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	8	0	1	4	1	H5533_008_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		27					0		0							0																15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	8	0	1	4	1	H5533_008_0	8	Generic	4	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		48					10		20							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	8	0	1	4	1	H5533_008_0	8	Preferred Brand	4	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		105							105																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	8	0	1	4	1	H5533_008_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	2			90				30		31								100		300					100		285							285																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5533	8	0	1	4	1	H5533_008_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1032.04	33						623.3	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5549	3	0	1	1	1	H5549_003_0	4	Preferred Generic	2	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	7	14	21																					21																7				7		0.23						0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5549	3	0	1	1	1	H5549_003_0	4	Generic	2	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	19	38	57																					57																19				19		0.63						0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5549	3	0	1	1	1	H5549_003_0	4	Preferred Brand	2	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5549	3	0	1	1	1	H5549_003_0	4	Non-Preferred Brand	2	10	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				99	39	39	39																				39															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5549	3	0	1	1	1	H5549_003_0	4	Specialty Tier	2	11	1	1	5	1	10		1	10		1	30								30						30		31				0	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	8	0	1	2	1	H5576_008_0	11	Preferred Generic	2	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	8	0	1	2	1	H5576_008_0	11	Generic	2	1	1	2	2	1	110		1		110	1	31		90				1	2				31		90	31		31	9		27																									9		27				9		27				9				9		0.29				0.29	0.29	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	8	0	1	2	1	H5576_008_0	11	Preferred Brand	2	10	1	1	3	1	110		1		110	1	31		90				1	2				31		90	31		31				106.86	25		25																								25		25				25		25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	8	0	1	2	1	H5576_008_0	11	Non-Preferred Brand	2	10	1	1	4	1	110		1		110	1	31		90				1	2				31		90	31		31				135.77	25		25																								25		25				25		25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	8	0	1	2	1	H5576_008_0	11	Specialty Tier	2	10	1	1	5	1	10		1		10	1	31											31			31		31				853.01	25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	1	1	2	1	H5576_017_1	10	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	1	1	2	1	H5576_017_1	10	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	12		36																											36						36				12				12		0.39						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	1	1	2	1	H5576_017_1	10	Preferred Brand	4	10	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	47		141																											141						141				47				47		1.52						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	1	1	2	1	H5576_017_1	10	Non-Preferred Brand	4	10	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	100		300																											300						300				100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	1	1	2	1	H5576_017_1	10	Specialty Tier	4	10	1	1	5	1	10		1			1	31														31		31				1413.59	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	2	1	2	1	H5576_017_2	10	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	2	1	2	1	H5576_017_2	10	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	12		36																											36						36				12				12		0.39						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	2	1	2	1	H5576_017_2	10	Preferred Brand	4	10	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	47		141																											141						141				47				47		1.52						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	2	1	2	1	H5576_017_2	10	Non-Preferred Brand	4	10	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	100		300																											300						300				100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	17	2	1	2	1	H5576_017_2	10	Specialty Tier	4	10	1	1	5	1	10		1			1	31														31		31				1413.59	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	1	1	2	1	H5576_018_1	10	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	1	1	2	1	H5576_018_1	10	Preferred Generic	4	1	1	2	1	3	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5576	18	1	1	2	1	H5576_018_1	10	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	12		36																											36						36				12				12		0.39						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	1	1	2	1	H5576_018_1	10	Preferred Brand	4	10	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	47		141																											141						141				47				47		1.52						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	1	1	2	1	H5576_018_1	10	Non-Preferred Brand	4	10	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	100		300																											300						300				100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	1	1	2	1	H5576_018_1	10	Specialty Tier	4	10	1	1	5	1	10		1			1	31														31		31				1927.78	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	2	1	2	1	H5576_018_2	10	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	2	1	2	1	H5576_018_2	10	Preferred Generic	4	1	1	2	1	3	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5576	18	2	1	2	1	H5576_018_2	10	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	12		36																											36						36				12				12		0.39						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	2	1	2	1	H5576_018_2	10	Preferred Brand	4	10	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	47		141																											141						141				47				47		1.52						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	2	1	2	1	H5576_018_2	10	Non-Preferred Brand	4	10	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	100		300																											300						300				100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	18	2	1	2	1	H5576_018_2	10	Specialty Tier	4	10	1	1	5	1	10		1			1	31														31		31				1927.78	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	19	0	1	2	1	H5576_019_0	11	Preferred Generic	2	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	19	0	1	2	1	H5576_019_0	11	Generic	2	1	1	2	2	1	110		1		110	1	31		90				1	2				31		90	31		31	9		27																									9		27				9		27				9				9		0.29				0.29	0.29	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	19	0	1	2	1	H5576_019_0	11	Preferred Brand	2	10	1	1	3	1	110		1		110	1	31		90				1	2				31		90	31		31				105.83	25		25																								25		25				25		25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	19	0	1	2	1	H5576_019_0	11	Non-Preferred Brand	2	10	1	1	4	1	110		1		110	1	31		90				1	2				31		90	31		31				130.69	25		25																								25		25				25		25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	19	0	1	2	1	H5576_019_0	11	Specialty Tier	2	10	1	1	5	1	10		1		10	1	31											31			31		31				968.49	25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	1	1	2	1	H5576_020_1	11	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	6		18																									6		18				0		0				6				6		0.19				0.19	0	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	1	1	2	1	H5576_020_1	11	Generic	4	1	1	2	2	1	110		1		110	1	31		90				1	2				31		90	31		31	15		45																									15		45				15		45				15				15		0.48				0.48	0.48	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	1	1	2	1	H5576_020_1	11	Preferred Brand	4	10	1	2	3	1	110		1		110	1	31		90				1	2				31		90	31		31	47		141																									47		141				47		141				47				47		1.52				1.52	1.52	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	1	1	2	1	H5576_020_1	11	Non-Preferred Brand	4	10	1	2	4	1	110		1		110	1	31		90				1	2				31		90	31		31	100		300																									100		300				100		300				100				100		3.23				3.23	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	1	1	2	1	H5576_020_1	11	Specialty Tier	4	10	1	1	5	1	10		1		10	1	31											31			31		31				965.34	25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	2	1	2	1	H5576_020_2	11	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	6		18																									6		18				0		0				6				6		0.19				0.19	0	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	2	1	2	1	H5576_020_2	11	Generic	4	1	1	2	2	1	110		1		110	1	31		90				1	2				31		90	31		31	15		45																									15		45				15		45				15				15		0.48				0.48	0.48	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	2	1	2	1	H5576_020_2	11	Preferred Brand	4	10	1	2	3	1	110		1		110	1	31		90				1	2				31		90	31		31	47		141																									47		141				47		141				47				47		1.52				1.52	1.52	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	2	1	2	1	H5576_020_2	11	Non-Preferred Brand	4	10	1	2	4	1	110		1		110	1	31		90				1	2				31		90	31		31	100		300																									100		300				100		300				100				100		3.23				3.23	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	20	2	1	2	1	H5576_020_2	11	Specialty Tier	4	10	1	1	5	1	10		1		10	1	31											31			31		31				965.34	25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	22	0	1	2	1	H5576_022_0	11	Preferred Generic	4	1	1	2	1	1	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	22	0	1	2	1	H5576_022_0	11	Preferred Generic	4	1	1	2	1	3	110		1		110	1	31		90				1	2				31		90	31		31	4		12																									4		12				0		0				4				4		0.13				0.13	0	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5576	22	0	1	2	1	H5576_022_0	11	Generic	4	1	1	2	2	1	110		1		100	1	31		90				1	2						90	31		31	12		36																											36						36				12				12		0.39						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	22	0	1	2	1	H5576_022_0	11	Preferred Brand	4	10	1	2	3	1	110		1		100	1	31		90				1	2						90	31		31	47		141																											141						141				47				47		1.52						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	22	0	1	2	1	H5576_022_0	11	Non-Preferred Brand	4	10	1	2	4	1	110		1		100	1	31		90				1	2						90	31		31	100		300																											300						300				100				100		3.23						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5576	22	0	1	2	1	H5576_022_0	11	Specialty Tier	4	10	1	1	5	1	10		1			1	31														31		31				1573.45	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	5	0	1	1	1	H5577_005_0	7	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	5	0	1	1	1	H5577_005_0	7	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	5	0	1	1	1	H5577_005_0	7	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	5	0	1	1	1	H5577_005_0	7	Generic	4	1	3	2	2	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5577	5	0	1	1	1	H5577_005_0	7	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				2	1			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	5	0	1	1	1	H5577_005_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				2	1			90				30		31	14	28	42																					28																14				14		0.47						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	5	0	1	1	1	H5577_005_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	8	0	1	2	1	H5577_008_0	7	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	8	0	1	2	1	H5577_008_0	7	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	8	0	1	2	1	H5577_008_0	7	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	8	0	1	2	1	H5577_008_0	7	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	8	0	1	2	1	H5577_008_0	7	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				2	1			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	8	0	1	2	1	H5577_008_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				2	1			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	8	0	1	2	1	H5577_008_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	31	0	1	1	1	H5577_031_0	7	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	31	0	1	1	1	H5577_031_0	7	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	31	0	1	1	1	H5577_031_0	7	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	31	0	1	1	1	H5577_031_0	7	Generic	4	1	3	2	2	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H5577	31	0	1	1	1	H5577_031_0	7	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				2	1			90				30		31	6	12	18																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	31	0	1	1	1	H5577_031_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				2	1			90				30		31	16	32	48																					32																16				16		0.53						0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	31	0	1	1	1	H5577_031_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	38	0	1	1	1	H5577_038_0	7	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	38	0	1	1	1	H5577_038_0	7	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	38	0	1	1	1	H5577_038_0	7	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	38	0	1	1	1	H5577_038_0	7	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	38	0	1	1	1	H5577_038_0	7	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				2	1			90				30		31	5	10	15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	38	0	1	1	1	H5577_038_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				2	1			90				30		31	25	50	75																					50																25				25		0.83						0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	38	0	1	1	1	H5577_038_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	39	0	1	1	1	H5577_039_0	7	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	39	0	1	1	1	H5577_039_0	7	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	2	4	6																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	39	0	1	1	1	H5577_039_0	7	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				2	2			90				30		31	6	12	18																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	39	0	1	1	1	H5577_039_0	7	Generic	4	1	1	2	2	3	111		1	100		1	30	60	90				2	2			90				30		31	6	12	18																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5577	39	0	1	1	1	H5577_039_0	7	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				2	1			90				30		31	28	56	84																					56																28				28		0.93						0.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	39	0	1	1	1	H5577_039_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				2	1			90				30		31	55	110	165																					110																55				55		1.83						1.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5577	39	0	1	1	1	H5577_039_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5590	4	0	1	1	1	H5590_004_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	7																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	4	0	1	1	1	H5590_004_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	42																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	4	0	1	1	1	H5590_004_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	4	0	1	1	1	H5590_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	4	0	1	1	1	H5590_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	4	0	1	1	1	H5590_004_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	5	0	1	1	1	H5590_005_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	5	0	1	1	1	H5590_005_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	42																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	5	0	1	1	1	H5590_005_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	5	0	1	1	1	H5590_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	5	0	1	1	1	H5590_005_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	5	0	1	1	1	H5590_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	7	0	1	1	1	H5590_007_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	7	0	1	1	1	H5590_007_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	7	0	1	1	1	H5590_007_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	7	0	1	1	1	H5590_007_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	7	0	1	1	1	H5590_007_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	7	0	1	1	1	H5590_007_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	8	0	1	1	1	H5590_008_0	5	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	8	0	1	1	1	H5590_008_0	5	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	8	0	1	1	1	H5590_008_0	5	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	8	0	1	1	1	H5590_008_0	5	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	8	0	1	1	1	H5590_008_0	5	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5590	8	0	1	1	1	H5590_008_0	5	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5591	1	0	1	2	1	H5591_001_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	1	0	1	2	1	H5591_001_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	1	0	1	2	1	H5591_001_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	1	0	1	2	1	H5591_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	1	0	1	2	1	H5591_001_0	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	5	0	1	2	1	H5591_005_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	5	0	1	2	1	H5591_005_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	5	0	1	2	1	H5591_005_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	5	0	1	2	1	H5591_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	5	0	1	2	1	H5591_005_0	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	1	1	2	1	H5591_006_1	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	1	1	2	1	H5591_006_1	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	1	1	2	1	H5591_006_1	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	1	1	2	1	H5591_006_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	1	1	2	1	H5591_006_1	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	2	1	2	1	H5591_006_2	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	2	1	2	1	H5591_006_2	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	2	1	2	1	H5591_006_2	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	2	1	2	1	H5591_006_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	2	1	2	1	H5591_006_2	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	4	1	2	1	H5591_006_4	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	4	1	2	1	H5591_006_4	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	4	1	2	1	H5591_006_4	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	4	1	2	1	H5591_006_4	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	6	4	1	2	1	H5591_006_4	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	7	0	1	1	1	H5591_007_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	7	0	1	1	1	H5591_007_0	6	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5591	7	0	1	1	1	H5591_007_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	7	0	1	1	1	H5591_007_0	6	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5591	7	0	1	1	1	H5591_007_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	7	0	1	1	1	H5591_007_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	7	0	1	1	1	H5591_007_0	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	33	33	33				600	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	9	0	1	1	1	H5591_009_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	9	0	1	1	1	H5591_009_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	9	0	1	1	1	H5591_009_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	9	0	1	1	1	H5591_009_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	9	0	1	1	1	H5591_009_0	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	28	28	28				600	28	28	28				28	28	28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	13	0	1	1	1	H5591_013_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					4	8	10																4				4			0.13	0	0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	13	0	1	1	1	H5591_013_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					18	36	45																18				18			0.6	0.33	0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	13	0	1	1	1	H5591_013_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					47	94	117.5																47				47			1.57	1.33	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	13	0	1	1	1	H5591_013_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					100	200	250																100				100			3.33	3.17	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5591	13	0	1	1	1	H5591_013_0	6	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	28	28	28				600	28	28	28				28	28	28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5593	1	0	1	1	1	H5593_001_0	8	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5593	1	0	1	1	1	H5593_001_0	8	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5593	1	0	1	1	1	H5593_001_0	8	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5593	1	0	1	1	1	H5593_001_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5593	1	0	1	1	1	H5593_001_0	8	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				608.9	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5594	1	0	1	1	1	H5594_001_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	1	0	1	1	1	H5594_001_0	8	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	1	0	1	1	1	H5594_001_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	1	0	1	1	1	H5594_001_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	1	0	1	1	1	H5594_001_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	2	0	1	1	1	H5594_002_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	2	0	1	1	1	H5594_002_0	8	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	2	0	1	1	1	H5594_002_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	10		30																			10		20																10				10		0.33			0.33			0.29	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	2	0	1	1	1	H5594_002_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	65		195																			65		130																65				65		2.17			2.17			1.91	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	2	0	1	1	1	H5594_002_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	16	0	1	1	1	H5594_016_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	16	0	1	1	1	H5594_016_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	45		135																			45		135																45				45		1.5			1.5			1.32	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	16	0	1	1	1	H5594_016_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	95		285																			95		285																95				95		3.17			3.17			2.79	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	16	0	1	1	1	H5594_016_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	17	0	1	1	1	H5594_017_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	17	0	1	1	1	H5594_017_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	45		135																			45		135																45				45		1.5			1.5			1.32	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	17	0	1	1	1	H5594_017_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	95		285																			95		285																95				95		3.17			3.17			2.79	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	17	0	1	1	1	H5594_017_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					25																				25																	25			25								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	19	0	1	1	1	H5594_019_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	19	0	1	1	1	H5594_019_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	19	0	1	1	1	H5594_019_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	19	0	1	1	1	H5594_019_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	19	0	1	1	1	H5594_019_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	22	0	1	1	1	H5594_022_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	22	0	1	1	1	H5594_022_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	22	0	1	1	1	H5594_022_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	22	0	1	1	1	H5594_022_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	22	0	1	1	1	H5594_022_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	26	0	1	1	1	H5594_026_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	26	0	1	1	1	H5594_026_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	26	0	1	1	1	H5594_026_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	26	0	1	1	1	H5594_026_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	26	0	1	1	1	H5594_026_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	28	0	1	1	1	H5594_028_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	28	0	1	1	1	H5594_028_0	8	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H5594	28	0	1	1	1	H5594_028_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	20		60																			20		40																20				20		0.67			0.67			0.59	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	28	0	1	1	1	H5594_028_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	60		180																			60		120																60				60		2			2			1.76	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	28	0	1	1	1	H5594_028_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	28	0	1	1	1	H5594_028_0	8	Select Diabetic Drugs	4	10	1	2	5	1	110		1	110		1	30		90				1	2	30		90				30		34	10		30																			10		20																10				10		0.33			0.33			0.29	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	29	0	1	1	1	H5594_029_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	29	0	1	1	1	H5594_029_0	8	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	29	0	1	1	1	H5594_029_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	20		60																			20		40																20				20		0.67			0.67			0.59	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	29	0	1	1	1	H5594_029_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	60		180																			60		120																60				60		2			2			1.76	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	29	0	1	1	1	H5594_029_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	30	0	1	1	1	H5594_030_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	30	0	1	1	1	H5594_030_0	8	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		3
H5594	30	0	1	1	1	H5594_030_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	30	0	1	1	1	H5594_030_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	80		240																			80		160																80				80		2.67			2.67			2.35	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	30	0	1	1	1	H5594_030_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	30	0	1	1	1	H5594_030_0	8	Select Diabetic Drugs	4	10	1	2	5	1	110		1	110		1	30		90				1	2	30		90				30		34	10		30																			10		20																10				10		0.33			0.33			0.29	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H5594	31	0	1	1	1	H5594_031_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	31	0	1	1	1	H5594_031_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	31	0	1	1	1	H5594_031_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	30		90																			30		60																30				30		1			1			0.88	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	31	0	1	1	1	H5594_031_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	80		240																			80		160																80				80		2.67			2.67			2.35	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	31	0	1	1	1	H5594_031_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	32	0	1	1	1	H5594_032_0	8	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	32	0	1	1	1	H5594_032_0	8	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	32	0	1	1	1	H5594_032_0	8	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	20		60																			20		40																20				20		0.67			0.67			0.59	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	32	0	1	1	1	H5594_032_0	8	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	60		180																			60		120																60				60		2			2			1.76	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	32	0	1	1	1	H5594_032_0	8	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	34	0	1	1	1	H5594_034_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	34	0	1	1	1	H5594_034_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	5		15																			5		10																5				5		0.17			0.17			0.15	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	34	0	1	1	1	H5594_034_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	34	0	1	1	1	H5594_034_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	34	0	1	1	1	H5594_034_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	35	0	1	1	1	H5594_035_0	9	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	35	0	1	1	1	H5594_035_0	9	Preferred Generic	4	11	3	2	1	3	110		1	110		1	30		90				2	2	30		90				30		34	5		15																			5		10																5				5		0.17			0.17			0.15	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5594	35	0	1	1	1	H5594_035_0	9	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	35		105																			35		70																35				35		1.17			1.17			1.03	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	35	0	1	1	1	H5594_035_0	9	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	85		255																			85		170																85				85		2.83			2.83			2.5	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5594	35	0	1	1	1	H5594_035_0	9	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5608	2	0	1	1	1	H5608_002_0	6	Preferred Generic	4	1	1	2	1	1	111		10	100		1	30	60	90				1	2			90					10	31	3	6	6																					6																	3			3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5608	2	0	1	1	1	H5608_002_0	6	Generic	4	1	1	2	2	1	111		10	100		1	30	60	90				1	2			90					10	31	9	18	18																					18																	9			9		0.3						0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5608	2	0	1	1	1	H5608_002_0	6	Preferred Brand	4	10	1	1	3	1	111		10	100		1	30	60	90				1	2			90					10	31				40.3	25	25	25																				25																25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5608	2	0	1	1	1	H5608_002_0	6	Non-Preferred Brand	4	10	1	1	4	1	111		10	100		1	30	60	90				1	2			90					10	31				36.05	50	50	50																				50																50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5608	2	0	1	1	1	H5608_002_0	6	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				294.1	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5608	2	0	1	1	1	H5608_002_0	6	Select Care Drugs	4	1	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5619	1	0	1	1	1	H5619_001_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	1	0	1	1	1	H5619_001_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	1	0	1	1	1	H5619_001_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	1	0	1	1	1	H5619_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	1	0	1	1	1	H5619_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	3	0	1	1	1	H5619_003_0	5	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	3	0	1	1	1	H5619_003_0	5	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					18		54											20		60				18		0				20				20			0.67	0.6		0.67	0.6	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	3	0	1	1	1	H5619_003_0	5	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	3	0	1	1	1	H5619_003_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	3	0	1	1	1	H5619_003_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	12	0	1	1	1	H5619_012_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	12	0	1	1	1	H5619_012_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	12	0	1	1	1	H5619_012_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	12	0	1	1	1	H5619_012_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	12	0	1	1	1	H5619_012_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	13	0	1	1	1	H5619_013_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	13	0	1	1	1	H5619_013_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	13	0	1	1	1	H5619_013_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	13	0	1	1	1	H5619_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	13	0	1	1	1	H5619_013_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	15	0	1	1	1	H5619_015_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	15	0	1	1	1	H5619_015_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	15	0	1	1	1	H5619_015_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	15	0	1	1	1	H5619_015_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	15	0	1	1	1	H5619_015_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	16	0	1	1	1	H5619_016_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	16	0	1	1	1	H5619_016_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	16	0	1	1	1	H5619_016_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	16	0	1	1	1	H5619_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	16	0	1	1	1	H5619_016_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	21	0	1	1	1	H5619_021_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	21	0	1	1	1	H5619_021_0	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5619	21	0	1	1	1	H5619_021_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	21	0	1	1	1	H5619_021_0	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5619	21	0	1	1	1	H5619_021_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					35		105											47		141				35		70				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	21	0	1	1	1	H5619_021_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	21	0	1	1	1	H5619_021_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	23	0	1	1	1	H5619_023_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	23	0	1	1	1	H5619_023_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	23	0	1	1	1	H5619_023_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	23	0	1	1	1	H5619_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	23	0	1	1	1	H5619_023_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	26	0	1	1	1	H5619_026_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	26	0	1	1	1	H5619_026_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	26	0	1	1	1	H5619_026_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	26	0	1	1	1	H5619_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	26	0	1	1	1	H5619_026_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	29	0	1	1	1	H5619_029_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	29	0	1	1	1	H5619_029_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	29	0	1	1	1	H5619_029_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	29	0	1	1	1	H5619_029_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	29	0	1	1	1	H5619_029_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	32	0	1	1	1	H5619_032_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	32	0	1	1	1	H5619_032_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	32	0	1	1	1	H5619_032_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		94				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	32	0	1	1	1	H5619_032_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	32	0	1	1	1	H5619_032_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	37	0	1	1	1	H5619_037_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	37	0	1	1	1	H5619_037_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	37	0	1	1	1	H5619_037_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	37	0	1	1	1	H5619_037_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	37	0	1	1	1	H5619_037_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	38	0	1	1	1	H5619_038_0	7	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	38	0	1	1	1	H5619_038_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	38	0	1	1	1	H5619_038_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	38	0	1	1	1	H5619_038_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	38	0	1	1	1	H5619_038_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	1	1	1	1	H5619_039_1	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	1	1	1	1	H5619_039_1	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	1	1	1	1	H5619_039_1	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		94				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	1	1	1	1	H5619_039_1	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	1	1	1	1	H5619_039_1	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	2	1	1	1	H5619_039_2	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	2	1	1	1	H5619_039_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	2	1	1	1	H5619_039_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		94				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	2	1	1	1	H5619_039_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	39	2	1	1	1	H5619_039_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	1	1	1	1	H5619_040_1	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	1	1	1	1	H5619_040_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	1	1	1	1	H5619_040_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	1	1	1	1	H5619_040_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	1	1	1	1	H5619_040_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	2	1	1	1	H5619_040_2	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	2	1	1	1	H5619_040_2	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	2	1	1	1	H5619_040_2	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	2	1	1	1	H5619_040_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	2	1	1	1	H5619_040_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	3	1	1	1	H5619_040_3	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	3	1	1	1	H5619_040_3	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	3	1	1	1	H5619_040_3	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	3	1	1	1	H5619_040_3	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	40	3	1	1	1	H5619_040_3	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	41	0	1	1	1	H5619_041_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	41	0	1	1	1	H5619_041_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	41	0	1	1	1	H5619_041_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	41	0	1	1	1	H5619_041_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	41	0	1	1	1	H5619_041_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	1	1	1	1	H5619_042_1	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	1	1	1	1	H5619_042_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	1	1	1	1	H5619_042_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	1	1	1	1	H5619_042_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	1	1	1	1	H5619_042_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	2	1	1	1	H5619_042_2	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	2	1	1	1	H5619_042_2	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	2	1	1	1	H5619_042_2	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	2	1	1	1	H5619_042_2	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	42	2	1	1	1	H5619_042_2	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	44	0	1	1	1	H5619_044_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	44	0	1	1	1	H5619_044_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	44	0	1	1	1	H5619_044_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	44	0	1	1	1	H5619_044_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	44	0	1	1	1	H5619_044_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	45	0	1	1	1	H5619_045_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	45	0	1	1	1	H5619_045_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	45	0	1	1	1	H5619_045_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	45	0	1	1	1	H5619_045_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	45	0	1	1	1	H5619_045_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	46	0	1	1	1	H5619_046_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	46	0	1	1	1	H5619_046_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	46	0	1	1	1	H5619_046_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	46	0	1	1	1	H5619_046_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	46	0	1	1	1	H5619_046_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	46	0	1	1	1	H5619_046_0	4	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	47	0	1	1	1	H5619_047_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	47	0	1	1	1	H5619_047_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	47	0	1	1	1	H5619_047_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	47	0	1	1	1	H5619_047_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	47	0	1	1	1	H5619_047_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	49	0	1	1	1	H5619_049_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	49	0	1	1	1	H5619_049_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	49	0	1	1	1	H5619_049_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	49	0	1	1	1	H5619_049_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	49	0	1	1	1	H5619_049_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	50	0	1	1	1	H5619_050_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	50	0	1	1	1	H5619_050_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	50	0	1	1	1	H5619_050_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	50	0	1	1	1	H5619_050_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	50	0	1	1	1	H5619_050_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	51	0	1	1	1	H5619_051_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	51	0	1	1	1	H5619_051_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	51	0	1	1	1	H5619_051_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	51	0	1	1	1	H5619_051_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	51	0	1	1	1	H5619_051_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	52	0	1	1	1	H5619_052_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	52	0	1	1	1	H5619_052_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	52	0	1	1	1	H5619_052_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	52	0	1	1	1	H5619_052_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	52	0	1	1	1	H5619_052_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	53	0	1	1	1	H5619_053_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	53	0	1	1	1	H5619_053_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	53	0	1	1	1	H5619_053_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	53	0	1	1	1	H5619_053_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	53	0	1	1	1	H5619_053_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	54	0	1	1	1	H5619_054_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	54	0	1	1	1	H5619_054_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	54	0	1	1	1	H5619_054_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	54	0	1	1	1	H5619_054_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	54	0	1	1	1	H5619_054_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	55	0	1	1	1	H5619_055_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	55	0	1	1	1	H5619_055_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	55	0	1	1	1	H5619_055_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	55	0	1	1	1	H5619_055_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	55	0	1	1	1	H5619_055_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	55	0	1	1	1	H5619_055_0	3	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					7		21											11		33				7		0				11				11			0.37	0.23		0.37	0.23	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	56	0	1	1	1	H5619_056_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	56	0	1	1	1	H5619_056_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	56	0	1	1	1	H5619_056_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	56	0	1	1	1	H5619_056_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	56	0	1	1	1	H5619_056_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	57	0	1	1	1	H5619_057_0	5	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	57	0	1	1	1	H5619_057_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	57	0	1	1	1	H5619_057_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	57	0	1	1	1	H5619_057_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	57	0	1	1	1	H5619_057_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	59	0	1	1	1	H5619_059_0	7	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	59	0	1	1	1	H5619_059_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	59	0	1	1	1	H5619_059_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	59	0	1	1	1	H5619_059_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	59	0	1	1	1	H5619_059_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	60	0	1	1	1	H5619_060_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	60	0	1	1	1	H5619_060_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	60	0	1	1	1	H5619_060_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	60	0	1	1	1	H5619_060_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	60	0	1	1	1	H5619_060_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	61	0	1	1	1	H5619_061_0	6	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	61	0	1	1	1	H5619_061_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	61	0	1	1	1	H5619_061_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	61	0	1	1	1	H5619_061_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	61	0	1	1	1	H5619_061_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	62	0	1	1	1	H5619_062_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	62	0	1	1	1	H5619_062_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	62	0	1	1	1	H5619_062_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	62	0	1	1	1	H5619_062_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	62	0	1	1	1	H5619_062_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	63	0	1	1	1	H5619_063_0	7	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	63	0	1	1	1	H5619_063_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	63	0	1	1	1	H5619_063_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	63	0	1	1	1	H5619_063_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	63	0	1	1	1	H5619_063_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	64	0	1	1	1	H5619_064_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	64	0	1	1	1	H5619_064_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	64	0	1	1	1	H5619_064_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	64	0	1	1	1	H5619_064_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	64	0	1	1	1	H5619_064_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	65	0	1	1	1	H5619_065_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	65	0	1	1	1	H5619_065_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	65	0	1	1	1	H5619_065_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	65	0	1	1	1	H5619_065_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	65	0	1	1	1	H5619_065_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	66	0	1	1	1	H5619_066_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	66	0	1	1	1	H5619_066_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	66	0	1	1	1	H5619_066_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	66	0	1	1	1	H5619_066_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	66	0	1	1	1	H5619_066_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	67	0	1	1	1	H5619_067_0	6	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	67	0	1	1	1	H5619_067_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	67	0	1	1	1	H5619_067_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	67	0	1	1	1	H5619_067_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	67	0	1	1	1	H5619_067_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	69	0	1	1	1	H5619_069_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	69	0	1	1	1	H5619_069_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	69	0	1	1	1	H5619_069_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	69	0	1	1	1	H5619_069_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	69	0	1	1	1	H5619_069_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	71	0	1	1	1	H5619_071_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	71	0	1	1	1	H5619_071_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	71	0	1	1	1	H5619_071_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	71	0	1	1	1	H5619_071_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	71	0	1	1	1	H5619_071_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	73	0	1	1	1	H5619_073_0	7	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	73	0	1	1	1	H5619_073_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	73	0	1	1	1	H5619_073_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	73	0	1	1	1	H5619_073_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	73	0	1	1	1	H5619_073_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	75	0	1	1	1	H5619_075_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	75	0	1	1	1	H5619_075_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	75	0	1	1	1	H5619_075_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	75	0	1	1	1	H5619_075_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	75	0	1	1	1	H5619_075_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	76	0	1	1	1	H5619_076_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	76	0	1	1	1	H5619_076_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	76	0	1	1	1	H5619_076_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	76	0	1	1	1	H5619_076_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	76	0	1	1	1	H5619_076_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	77	0	1	1	1	H5619_077_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	77	0	1	1	1	H5619_077_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	77	0	1	1	1	H5619_077_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	77	0	1	1	1	H5619_077_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	77	0	1	1	1	H5619_077_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	78	0	1	1	1	H5619_078_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	78	0	1	1	1	H5619_078_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	78	0	1	1	1	H5619_078_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	78	0	1	1	1	H5619_078_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	78	0	1	1	1	H5619_078_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	79	0	1	1	1	H5619_079_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	79	0	1	1	1	H5619_079_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	79	0	1	1	1	H5619_079_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	79	0	1	1	1	H5619_079_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	79	0	1	1	1	H5619_079_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	80	0	1	1	1	H5619_080_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	80	0	1	1	1	H5619_080_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	80	0	1	1	1	H5619_080_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	80	0	1	1	1	H5619_080_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	80	0	1	1	1	H5619_080_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	81	0	1	1	1	H5619_081_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	81	0	1	1	1	H5619_081_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	81	0	1	1	1	H5619_081_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	81	0	1	1	1	H5619_081_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	81	0	1	1	1	H5619_081_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	82	0	1	1	1	H5619_082_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	82	0	1	1	1	H5619_082_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	82	0	1	1	1	H5619_082_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	82	0	1	1	1	H5619_082_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	82	0	1	1	1	H5619_082_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	83	0	1	1	1	H5619_083_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	83	0	1	1	1	H5619_083_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	83	0	1	1	1	H5619_083_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	83	0	1	1	1	H5619_083_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	83	0	1	1	1	H5619_083_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	84	0	1	1	1	H5619_084_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	84	0	1	1	1	H5619_084_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	84	0	1	1	1	H5619_084_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	84	0	1	1	1	H5619_084_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	84	0	1	1	1	H5619_084_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	86	0	1	1	1	H5619_086_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	86	0	1	1	1	H5619_086_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	86	0	1	1	1	H5619_086_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	86	0	1	1	1	H5619_086_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	86	0	1	1	1	H5619_086_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	87	0	1	1	1	H5619_087_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	87	0	1	1	1	H5619_087_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	87	0	1	1	1	H5619_087_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	87	0	1	1	1	H5619_087_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	87	0	1	1	1	H5619_087_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	87	0	1	1	1	H5619_087_0	3	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5619	88	0	1	1	1	H5619_088_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	88	0	1	1	1	H5619_088_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	88	0	1	1	1	H5619_088_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	88	0	1	1	1	H5619_088_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	88	0	1	1	1	H5619_088_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	89	0	1	1	1	H5619_089_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	89	0	1	1	1	H5619_089_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	89	0	1	1	1	H5619_089_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	89	0	1	1	1	H5619_089_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	89	0	1	1	1	H5619_089_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	90	0	1	1	1	H5619_090_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	90	0	1	1	1	H5619_090_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	90	0	1	1	1	H5619_090_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	90	0	1	1	1	H5619_090_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	90	0	1	1	1	H5619_090_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	91	0	1	1	1	H5619_091_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	91	0	1	1	1	H5619_091_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	91	0	1	1	1	H5619_091_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	91	0	1	1	1	H5619_091_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	91	0	1	1	1	H5619_091_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	93	0	1	1	1	H5619_093_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	93	0	1	1	1	H5619_093_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	93	0	1	1	1	H5619_093_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	93	0	1	1	1	H5619_093_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	93	0	1	1	1	H5619_093_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	94	0	1	1	1	H5619_094_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	94	0	1	1	1	H5619_094_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	94	0	1	1	1	H5619_094_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	94	0	1	1	1	H5619_094_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	94	0	1	1	1	H5619_094_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	95	0	1	1	1	H5619_095_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	95	0	1	1	1	H5619_095_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	95	0	1	1	1	H5619_095_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	95	0	1	1	1	H5619_095_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	95	0	1	1	1	H5619_095_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	97	0	1	1	1	H5619_097_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	97	0	1	1	1	H5619_097_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	97	0	1	1	1	H5619_097_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	97	0	1	1	1	H5619_097_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	97	0	1	1	1	H5619_097_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	99	0	1	1	1	H5619_099_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	99	0	1	1	1	H5619_099_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	99	0	1	1	1	H5619_099_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	99	0	1	1	1	H5619_099_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	99	0	1	1	1	H5619_099_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	100	0	1	1	1	H5619_100_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	100	0	1	1	1	H5619_100_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	100	0	1	1	1	H5619_100_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	100	0	1	1	1	H5619_100_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	100	0	1	1	1	H5619_100_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	101	0	1	1	1	H5619_101_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	101	0	1	1	1	H5619_101_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	101	0	1	1	1	H5619_101_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	101	0	1	1	1	H5619_101_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	101	0	1	1	1	H5619_101_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												32							32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	102	0	1	1	1	H5619_102_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	102	0	1	1	1	H5619_102_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	102	0	1	1	1	H5619_102_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	102	0	1	1	1	H5619_102_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	102	0	1	1	1	H5619_102_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	109	0	1	1	1	H5619_109_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	109	0	1	1	1	H5619_109_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	109	0	1	1	1	H5619_109_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	109	0	1	1	1	H5619_109_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	109	0	1	1	1	H5619_109_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	110	0	1	1	1	H5619_110_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	110	0	1	1	1	H5619_110_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	110	0	1	1	1	H5619_110_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	110	0	1	1	1	H5619_110_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	110	0	1	1	1	H5619_110_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	111	0	1	1	1	H5619_111_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	111	0	1	1	1	H5619_111_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	111	0	1	1	1	H5619_111_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	111	0	1	1	1	H5619_111_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	111	0	1	1	1	H5619_111_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	112	0	1	1	1	H5619_112_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	112	0	1	1	1	H5619_112_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	112	0	1	1	1	H5619_112_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	112	0	1	1	1	H5619_112_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	112	0	1	1	1	H5619_112_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	113	0	1	1	1	H5619_113_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	113	0	1	1	1	H5619_113_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	113	0	1	1	1	H5619_113_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	113	0	1	1	1	H5619_113_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	113	0	1	1	1	H5619_113_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	114	0	1	1	1	H5619_114_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	114	0	1	1	1	H5619_114_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	114	0	1	1	1	H5619_114_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	114	0	1	1	1	H5619_114_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	114	0	1	1	1	H5619_114_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	115	0	1	1	1	H5619_115_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	115	0	1	1	1	H5619_115_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	115	0	1	1	1	H5619_115_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	115	0	1	1	1	H5619_115_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	115	0	1	1	1	H5619_115_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	116	0	1	1	1	H5619_116_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	116	0	1	1	1	H5619_116_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	116	0	1	1	1	H5619_116_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		94				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	116	0	1	1	1	H5619_116_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	116	0	1	1	1	H5619_116_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	117	0	1	1	1	H5619_117_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	117	0	1	1	1	H5619_117_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	117	0	1	1	1	H5619_117_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	117	0	1	1	1	H5619_117_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	117	0	1	1	1	H5619_117_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	118	0	1	1	1	H5619_118_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	118	0	1	1	1	H5619_118_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	118	0	1	1	1	H5619_118_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	118	0	1	1	1	H5619_118_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	118	0	1	1	1	H5619_118_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	119	0	1	1	1	H5619_119_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	119	0	1	1	1	H5619_119_0	3	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H5619	119	0	1	1	1	H5619_119_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	119	0	1	1	1	H5619_119_0	3	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5619	119	0	1	1	1	H5619_119_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		94				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	119	0	1	1	1	H5619_119_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	119	0	1	1	1	H5619_119_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	122	0	1	1	1	H5619_122_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	122	0	1	1	1	H5619_122_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	122	0	1	1	1	H5619_122_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	122	0	1	1	1	H5619_122_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	122	0	1	1	1	H5619_122_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	123	0	1	1	1	H5619_123_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	123	0	1	1	1	H5619_123_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	123	0	1	1	1	H5619_123_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	123	0	1	1	1	H5619_123_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	123	0	1	1	1	H5619_123_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	124	0	1	1	1	H5619_124_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	124	0	1	1	1	H5619_124_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	124	0	1	1	1	H5619_124_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	124	0	1	1	1	H5619_124_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	124	0	1	1	1	H5619_124_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	125	0	1	1	1	H5619_125_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	125	0	1	1	1	H5619_125_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	125	0	1	1	1	H5619_125_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	125	0	1	1	1	H5619_125_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	125	0	1	1	1	H5619_125_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	126	0	1	1	1	H5619_126_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	126	0	1	1	1	H5619_126_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	126	0	1	1	1	H5619_126_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	126	0	1	1	1	H5619_126_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	126	0	1	1	1	H5619_126_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	128	0	1	1	1	H5619_128_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	128	0	1	1	1	H5619_128_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	128	0	1	1	1	H5619_128_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	128	0	1	1	1	H5619_128_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	128	0	1	1	1	H5619_128_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	129	0	1	1	1	H5619_129_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	129	0	1	1	1	H5619_129_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	129	0	1	1	1	H5619_129_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	129	0	1	1	1	H5619_129_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5619	129	0	1	1	1	H5619_129_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	1	0	1	1	1	H5628_001_0	7	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	1	0	1	1	1	H5628_001_0	7	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	1	0	1	1	1	H5628_001_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	23	46	69																			23	46	69																23				23		0.74			0.74			0.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	1	0	1	1	1	H5628_001_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				88.27	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	1	0	1	1	1	H5628_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				431.99	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	7	0	1	1	1	H5628_007_0	8	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	2	4	6																			2	4	4																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	7	0	1	1	1	H5628_007_0	8	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	8	16	24																			8	16	16																8				8		0.26			0.26			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	7	0	1	1	1	H5628_007_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	45	90	135																			45	90	90																45				45		1.45			1.45			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	7	0	1	1	1	H5628_007_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	100	200	300																			100	200	300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	7	0	1	1	1	H5628_007_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				762.62	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	7	0	1	1	1	H5628_007_0	8	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	8	0	1	1	1	H5628_008_0	8	Preferred Generic	2	11	1	1	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	8	0	1	1	1	H5628_008_0	8	Generic	2	11	1	1	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	8	0	1	1	1	H5628_008_0	8	Preferred Brand	2	11	1	1	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	8	0	1	1	1	H5628_008_0	8	Non-Preferred Drug	2	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	8	0	1	1	1	H5628_008_0	8	Specialty Tier	2	11	1	1	5	1	10		1	10		1	31								31						31		31					25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5628	9	0	1	1	1	H5628_009_0	8	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	9	0	1	1	1	H5628_009_0	8	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	6	12	18																			6	12	12																6				6		0.19			0.19			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	9	0	1	1	1	H5628_009_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	45	90	135																			45	90	90																45				45		1.45			1.45			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	9	0	1	1	1	H5628_009_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	100	200	300																			100	200	300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	9	0	1	1	1	H5628_009_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				753.67	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	9	0	1	1	1	H5628_009_0	8	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	10	0	1	1	1	H5628_010_0	8	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	10	0	1	1	1	H5628_010_0	8	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	6	12	18																			6	12	12																6				6		0.19			0.19			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	10	0	1	1	1	H5628_010_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	45	90	135																			45	90	90																45				45		1.45			1.45			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	10	0	1	1	1	H5628_010_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	100	200	300																			100	200	300																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	10	0	1	1	1	H5628_010_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				679.75	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5628	10	0	1	1	1	H5628_010_0	8	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5644	2	0	1	1	1	H5644_002_0	8	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								4		10					2		5					2		0																2				2			0.13	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5644	2	0	1	1	1	H5644_002_0	8	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								14		35					8		20					8		20																8				8			0.47	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5644	2	0	1	1	1	H5644_002_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		118					42		105					42		105																42				42			1.57	1.4	1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5644	2	0	1	1	1	H5644_002_0	8	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								91		228					84		210					84		210																84				84			3.03	2.8	2.8			2.71	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5644	2	0	1	1	1	H5644_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5649	1	0	1	1	1	H5649_001_0	5	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	1	0	1	1	1	H5649_001_0	5	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	1	0	1	1	1	H5649_001_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	1	0	1	1	1	H5649_001_0	5	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	1	0	1	1	1	H5649_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	35		105																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	1	0	1	1	1	H5649_001_0	5	Non-Preferred Drug	4	11	3	2	4	1	110		1	100		1	30		90				1	2			90				30		31	75		225																					150																75				75		2.5						2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	1	0	1	1	1	H5649_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				744.09	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	1	0	1	1	1	H5649_001_0	5	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	2	0	1	1	1	H5649_002_0	5	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	2	0	1	1	1	H5649_002_0	5	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	2	0	1	1	1	H5649_002_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	2	0	1	1	1	H5649_002_0	5	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	2	0	1	1	1	H5649_002_0	5	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		31				117.2	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	2	0	1	1	1	H5649_002_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		1	100		1	30		90				1	2			90				30		31				59.04	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	2	0	1	1	1	H5649_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				487.29	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	2	0	1	1	1	H5649_002_0	5	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	4	0	1	1	1	H5649_004_0	5	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	4	0	1	1	1	H5649_004_0	5	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	4	0	1	1	1	H5649_004_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	4	0	1	1	1	H5649_004_0	5	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	4	0	1	1	1	H5649_004_0	5	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		31				120.47	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	4	0	1	1	1	H5649_004_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		1	100		1	30		90				1	2			90				30		31				56.58	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	4	0	1	1	1	H5649_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				616.86	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	4	0	1	1	1	H5649_004_0	5	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	6	0	1	1	1	H5649_006_0	5	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	6	0	1	1	1	H5649_006_0	5	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	6	0	1	1	1	H5649_006_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	6	0	1	1	1	H5649_006_0	5	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	6	0	1	1	1	H5649_006_0	5	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	35		105																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	6	0	1	1	1	H5649_006_0	5	Non-Preferred Drug	4	11	3	2	4	1	110		1	100		1	30		90				1	2			90				30		31	75		225																					150																75				75		2.5						2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	6	0	1	1	1	H5649_006_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				815.17	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	6	0	1	1	1	H5649_006_0	5	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	6	0	1	1	1	H5649_006_0	5	Select Care Drugs	4	10	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	8	0	1	1	1	H5649_008_0	5	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	8	0	1	1	1	H5649_008_0	5	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	8	0	1	1	1	H5649_008_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	8	0	1	1	1	H5649_008_0	5	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	8	0	1	1	1	H5649_008_0	5	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	8	0	1	1	1	H5649_008_0	5	Non-Preferred Drug	4	11	3	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	8	0	1	1	1	H5649_008_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				842.99	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	8	0	1	1	1	H5649_008_0	5	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	9	0	1	1	1	H5649_009_0	5	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	9	0	1	1	1	H5649_009_0	5	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	9	0	1	1	1	H5649_009_0	5	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	9	0	1	1	1	H5649_009_0	5	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	9	0	1	1	1	H5649_009_0	5	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		31				118.96	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	9	0	1	1	1	H5649_009_0	5	Non-Preferred Drug	4	11	3	1	4	1	110		1	100		1	30		90				1	2			90				30		31				59.95	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	9	0	1	1	1	H5649_009_0	5	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				604.24	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	9	0	1	1	1	H5649_009_0	5	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	13	0	1	1	1	H5649_013_0	6	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	13	0	1	1	1	H5649_013_0	6	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	13	0	1	1	1	H5649_013_0	6	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	13	0	1	1	1	H5649_013_0	6	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	13	0	1	1	1	H5649_013_0	6	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					80																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	13	0	1	1	1	H5649_013_0	6	Non-Preferred Drug	4	11	3	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	13	0	1	1	1	H5649_013_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				740.06	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	13	0	1	1	1	H5649_013_0	6	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	14	0	1	1	1	H5649_014_0	6	Preferred Generic	4	11	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	14	0	1	1	1	H5649_014_0	6	Preferred Generic	4	11	3	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H5649	14	0	1	1	1	H5649_014_0	6	Generic	4	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	14	0	1	1	1	H5649_014_0	6	Generic	4	11	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5649	14	0	1	1	1	H5649_014_0	6	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				1	2			90				30		31				119.01	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	14	0	1	1	1	H5649_014_0	6	Non-Preferred Drug	4	11	3	1	4	1	110		1	100		1	30		90				1	2			90				30		31				54.56	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	14	0	1	1	1	H5649_014_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				612.84	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5649	14	0	1	1	1	H5649_014_0	6	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5652	1	0	1	2	1	H5652_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	1	0	1	2	1	H5652_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	15		45																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	1	0	1	2	1	H5652_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	1	0	1	2	1	H5652_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	85		255																											255						245				85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	1	0	1	2	1	H5652_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1355	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	3	0	1	2	1	H5652_003_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	3	0	1	2	1	H5652_003_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	0		0																											0						0				0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	3	0	1	2	1	H5652_003_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	28		84																											84						74				28				28		0.93						0.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	3	0	1	2	1	H5652_003_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	70		210																											210						200				70				70		2.33						2.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	3	0	1	2	1	H5652_003_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				426	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	4	0	1	2	1	H5652_004_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	4	0	1	2	1	H5652_004_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	4	0	1	2	1	H5652_004_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	4	0	1	2	1	H5652_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	85		255																											255						245				85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	4	0	1	2	1	H5652_004_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1128	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	6	0	1	2	1	H5652_006_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	6	0	1	2	1	H5652_006_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	15		45																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	6	0	1	2	1	H5652_006_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	6	0	1	2	1	H5652_006_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	85		255																											255						245				85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	6	0	1	2	1	H5652_006_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				759	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	8	0	1	1	1	H5652_008_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	5		15																											15						0				5				5		0.16						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	8	0	1	1	1	H5652_008_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	20		60																											60						0				20				20		0.66						0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	8	0	1	1	1	H5652_008_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	8	0	1	1	1	H5652_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5652	8	0	1	1	1	H5652_008_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				584	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5656	1	0	1	1	1	H5656_001_0	6	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		12.5					0		0											5		12.5				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5656	1	0	1	1	1	H5656_001_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								10		25					5		12.5											10		25				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5656	1	0	1	1	1	H5656_001_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		112.5					35		87.5											45		112.5				35		70				45				45			1.5	1.17		1.5	1.17	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5656	1	0	1	1	1	H5656_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	1	2				30		90	30		31								85		212.5					75		187.5											85		212.5				75		150				85				85			2.83	2.5		2.83	2.5	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5656	1	0	1	1	1	H5656_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5746	16	0	1	1	1	H5746_016_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	16	0	1	1	1	H5746_016_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					7	14	21					7	21	21																7				7			0.23	0.23	0.23			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	16	0	1	1	1	H5746_016_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	16	0	1	1	1	H5746_016_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	16	0	1	1	1	H5746_016_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	16	0	1	1	1	H5746_016_0	10	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	16	0	1	1	1	H5746_016_0	10	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5746	18	0	1	1	1	H5746_018_0	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					5	10	15					5	15	15																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	18	0	1	1	1	H5746_018_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	18	0	1	1	1	H5746_018_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	18	0	1	1	1	H5746_018_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	18	0	1	1	1	H5746_018_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	18	0	1	1	1	H5746_018_0	10	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5746	18	0	1	1	1	H5746_018_0	10	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5774	5	0	1	1	1	H5774_005_0	4	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	5	0	1	1	1	H5774_005_0	4	Preferred Generic	4	1	1	2	1	3		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	5	0	1	1	1	H5774_005_0	4	Generic	4	1	3	2	2	1		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	5	0	1	1	1	H5774_005_0	4	Generic	4	1	3	2	2	3		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H5774	5	0	1	1	1	H5774_005_0	4	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								30		60					15		30							30																30				15			1	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	5	0	1	1	1	H5774_005_0	4	Non-Preferred Brand	4	10	3	2	4	1		110	1	100		1				30		90	1	1			90				30		31								55		110					35		70							70																55				35			1.83	1.17				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	5	0	1	1	1	H5774_005_0	4	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											33	33		33				33	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	5	0	1	1	1	H5774_005_0	4	Select Care Drugs	4	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	5	0	1	1	1	H5774_005_0	4	Select Care Drugs	4	11	1	2	6	3		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	22	0	1	1	1	H5774_022_0	5	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	22	0	1	1	1	H5774_022_0	5	Preferred Generic	4	1	1	2	1	3		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	22	0	1	1	1	H5774_022_0	5	Generic	4	1	3	2	2	1		110	1	100		1				30		90	1	2			90				30		31								8		16					0		0							0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	22	0	1	1	1	H5774_022_0	5	Generic	4	1	3	2	2	3		110	1	100		1				30		90	1	2			90				30		31								8		16					0		0							0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H5774	22	0	1	1	1	H5774_022_0	5	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								20		40					5		10							10																20				5			0.67	0.17				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	22	0	1	1	1	H5774_022_0	5	Non-Preferred Brand	4	10	3	2	4	1		110	1	100		1				30		90	1	1			90				30		31								55		110					20		40							40																55				20			1.83	0.67				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	22	0	1	1	1	H5774_022_0	5	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											33	33		33				33	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	22	0	1	1	1	H5774_022_0	5	Select Care Drugs	4	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	22	0	1	1	1	H5774_022_0	5	Select Care Drugs	4	11	1	2	6	3		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	23	0	1	2	1	H5774_023_0	4	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								8		16					2		4							4																8				2			0.27	0.07				0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	23	0	1	2	1	H5774_023_0	4	Preferred Generic	4	1	1	2	1	3		110	1	100		1				30		90	1	2			90				30		31								8		16					2		4							4																8				2			0.27	0.07				0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	23	0	1	2	1	H5774_023_0	4	Generic	4	1	3	2	2	1		110	1	100		1				30		90	1	2			90				30		31								12		24					6		12							12																12				6			0.4	0.2				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	23	0	1	2	1	H5774_023_0	4	Generic	4	1	3	2	2	3		110	1	100		1				30		90	1	2			90				30		31								12		24					6		12							12																12				6			0.4	0.2				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H5774	23	0	1	2	1	H5774_023_0	4	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								45		90					25		50							50																45				25			1.5	0.83				0.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	23	0	1	2	1	H5774_023_0	4	Non-Preferred Brand	4	10	3	2	4	1		110	1	100		1				30		90	1	1			90				30		31								60		120					45		90							90																60				45			2	1.5				1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	23	0	1	2	1	H5774_023_0	4	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											33	33		33				33	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	23	0	1	2	1	H5774_023_0	4	Select Care Drugs	4	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	23	0	1	2	1	H5774_023_0	4	Select Care Drugs	4	11	1	2	6	3		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	24	0	1	1	1	H5774_024_0	5	Preferred Generic	2	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								19		38					14		28							28																19				14			0.63	0.47				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	24	0	1	1	1	H5774_024_0	5	Generic	2	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	24	0	1	1	1	H5774_024_0	5	Preferred Brand	2	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	24	0	1	1	1	H5774_024_0	5	Non-Preferred Brand	2	10	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	24	0	1	1	1	H5774_024_0	5	Specialty Tier	2	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											15	25		25				15	25		25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	24	0	1	1	1	H5774_024_0	5	Select Care Drugs	2	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	25	0	1	1	1	H5774_025_0	5	Preferred Generic	2	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								19		38					14		28							28																19				14			0.63	0.47				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	25	0	1	1	1	H5774_025_0	5	Generic	2	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	25	0	1	1	1	H5774_025_0	5	Preferred Brand	2	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	25	0	1	1	1	H5774_025_0	5	Non-Preferred Brand	2	10	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	25	0	1	1	1	H5774_025_0	5	Specialty Tier	2	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											15	25		25				15	25		25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	25	0	1	1	1	H5774_025_0	5	Select Care Drugs	2	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								6		12					1		2							2																6				1			0.2	0.03				0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	26	0	1	1	1	H5774_026_0	9	Preferred Generic	2	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								19		38					18		36							36																19				18			0.63	0.6				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	26	0	1	1	1	H5774_026_0	9	Generic	2	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					19		38							38																20				19			0.67	0.63				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	26	0	1	1	1	H5774_026_0	9	Preferred Brand	2	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	26	0	1	1	1	H5774_026_0	9	Non-Preferred Brand	2	10	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	26	0	1	1	1	H5774_026_0	9	Specialty Tier	2	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											15	25		25				15	25		25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	26	0	1	1	1	H5774_026_0	9	Select Care Drugs	2	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								10		20					9		18							18																10				9			0.33	0.3				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	27	0	1	2	1	H5774_027_0	4	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	27	0	1	2	1	H5774_027_0	4	Preferred Generic	4	1	1	2	1	3		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	27	0	1	2	1	H5774_027_0	4	Generic	4	1	3	2	2	1		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	27	0	1	2	1	H5774_027_0	4	Generic	4	1	3	2	2	3		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H5774	27	0	1	2	1	H5774_027_0	4	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								30		60					10		20							20																30				10			1	0.33				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	27	0	1	2	1	H5774_027_0	4	Non-Preferred Brand	4	10	3	2	4	1		110	1	100		1				30		90	1	1			90				30		31								55		110					30		60							60																55				30			1.83	1				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	27	0	1	2	1	H5774_027_0	4	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											33	33		33				33	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	27	0	1	2	1	H5774_027_0	4	Select Care Drugs	4	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	27	0	1	2	1	H5774_027_0	4	Select Care Drugs	4	11	1	2	6	3		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	28	0	1	1	1	H5774_028_0	5	Preferred Generic	2	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								19		38					14		28							28																19				14			0.63	0.47				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	28	0	1	1	1	H5774_028_0	5	Generic	2	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	28	0	1	1	1	H5774_028_0	5	Preferred Brand	2	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	28	0	1	1	1	H5774_028_0	5	Non-Preferred Brand	2	10	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	28	0	1	1	1	H5774_028_0	5	Specialty Tier	2	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											15	25		25				15	25		25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	28	0	1	1	1	H5774_028_0	5	Select Care Drugs	2	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	31	0	1	2	1	H5774_031_0	4	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	31	0	1	2	1	H5774_031_0	4	Preferred Generic	4	1	1	2	1	3		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	31	0	1	2	1	H5774_031_0	4	Generic	4	1	3	2	2	1		110	1	100		1				30		90	1	2			90				30		31								8		16					0		0							0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	31	0	1	2	1	H5774_031_0	4	Generic	4	1	3	2	2	3		110	1	100		1				30		90	1	2			90				30		31								8		16					0		0							0																8				0			0.27	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H5774	31	0	1	2	1	H5774_031_0	4	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								20		40					5		10							10																20				5			0.67	0.17				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	31	0	1	2	1	H5774_031_0	4	Non-Preferred Brand	4	10	3	2	4	1		110	1	100		1				30		90	1	1			90				30		31								45		90					10		20							20																45				10			1.5	0.33				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	31	0	1	2	1	H5774_031_0	4	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											25	25		25				25	25		25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	31	0	1	2	1	H5774_031_0	4	Select Care Drugs	4	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	31	0	1	2	1	H5774_031_0	4	Select Care Drugs	4	11	1	2	6	3		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	32	0	1	1	1	H5774_032_0	6	Preferred Generic	2	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								19		38					14		28							28																19				14			0.63	0.47				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	32	0	1	1	1	H5774_032_0	6	Generic	2	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		40					15		30							30																20				15			0.67	0.5				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	32	0	1	1	1	H5774_032_0	6	Preferred Brand	2	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		94					42		84							84																47				42			1.57	1.4				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	32	0	1	1	1	H5774_032_0	6	Non-Preferred Brand	2	10	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		200					95		190							190																100				95			3.33	3.17				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	32	0	1	1	1	H5774_032_0	6	Specialty Tier	2	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											15	25		25				15	25		25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	32	0	1	1	1	H5774_032_0	6	Select Care Drugs	2	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								6		12					1		2							2																6				1			0.2	0.03				0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	33	0	1	1	1	H5774_033_0	5	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	33	0	1	1	1	H5774_033_0	5	Preferred Generic	4	1	1	2	1	3		110	1	100		1				30		90	1	2			90				30		31								5		10					0		0							0																5				0			0.17	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5774	33	0	1	1	1	H5774_033_0	5	Generic	4	1	3	2	2	1		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	33	0	1	1	1	H5774_033_0	5	Generic	4	1	3	2	2	3		110	1	100		1				30		90	1	2			90				30		31								8		16					3		6							6																8				3			0.27	0.1				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		3
H5774	33	0	1	1	1	H5774_033_0	5	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								45		90					20		40							40																45				20			1.5	0.67				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	33	0	1	1	1	H5774_033_0	5	Non-Preferred Brand	4	10	3	2	4	1		110	1	100		1				30		90	1	1			90				30		31								65		130					35		70							70																65				35			2.17	1.17				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	33	0	1	1	1	H5774_033_0	5	Specialty Tier	4	11	1	1	5	1		110	1	100		1				30		90	1	1			90				30		31											33	33		33				33	33		33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	33	0	1	1	1	H5774_033_0	5	Select Care Drugs	4	11	1	2	6	1		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5774	33	0	1	1	1	H5774_033_0	5	Select Care Drugs	4	11	1	2	6	3		110	1	100		1				30		90	1	2			90				30		31								3		6					0		0							0																3				0			0.1	0				0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5779	2	0	1	1	1	H5779_002_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	2	0	1	1	1	H5779_002_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	2	0	1	1	1	H5779_002_0	6	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	2	0	1	1	1	H5779_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	2	0	1	1	1	H5779_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	5	0	1	1	1	H5779_005_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	5	0	1	1	1	H5779_005_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	5	0	1	1	1	H5779_005_0	6	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	5	0	1	1	1	H5779_005_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	5	0	1	1	1	H5779_005_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	6	0	1	1	1	H5779_006_0	7	Preferred Generic	4	11	3	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	6	0	1	1	1	H5779_006_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	6	0	1	1	1	H5779_006_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	6	0	1	1	1	H5779_006_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				90.42	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	6	0	1	1	1	H5779_006_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	7	0	1	1	1	H5779_007_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	7	0	1	1	1	H5779_007_0	7	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5779	7	0	1	1	1	H5779_007_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	7	0	1	1	1	H5779_007_0	7	Preferred Brand	4	11	3	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	7	0	1	1	1	H5779_007_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5779	7	0	1	1	1	H5779_007_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5793	1	0	1	1	1	H5793_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	1	0	1	1	1	H5793_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5793	1	0	1	1	1	H5793_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	1	0	1	1	1	H5793_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5793	1	0	1	1	1	H5793_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	1	0	1	1	1	H5793_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	1	0	1	1	1	H5793_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											874.25	33						817.88	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	10	0	1	1	1	H5793_010_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	10	0	1	1	1	H5793_010_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5793	10	0	1	1	1	H5793_010_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	10	0	1	1	1	H5793_010_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5793	10	0	1	1	1	H5793_010_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	10	0	1	1	1	H5793_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	10	0	1	1	1	H5793_010_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											811.05	33						819.3	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	12	0	1	1	1	H5793_012_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	12	0	1	1	1	H5793_012_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5793	12	0	1	1	1	H5793_012_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	12	0	1	1	1	H5793_012_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5793	12	0	1	1	1	H5793_012_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	12	0	1	1	1	H5793_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5793	12	0	1	1	1	H5793_012_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											792.59	33						750.06	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H5810	1	0	1	1	1	H5810_001_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	1	0	1	1	1	H5810_001_0	6	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	14	28	42																			14	28	42																14				14		0.45			0.45			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	1	0	1	1	1	H5810_001_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	40	80	120																			40	80	120																40				40		1.29			1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	1	0	1	1	1	H5810_001_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				83.84	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	1	0	1	1	1	H5810_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				514.03	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	13	0	1	1	1	H5810_013_0	8	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	13	0	1	1	1	H5810_013_0	8	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	14	28	42																			14	28	42																14				14		0.45			0.45			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	13	0	1	1	1	H5810_013_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	40	80	120																			40	80	120																40				40		1.29			1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	13	0	1	1	1	H5810_013_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				82.06	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5810	13	0	1	1	1	H5810_013_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				493.53	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5823	6	0	1	1	1	H5823_006_0	7	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5823	6	0	1	1	1	H5823_006_0	7	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5823	6	0	1	1	1	H5823_006_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	29	58	87																			29	58	87																29				29		0.94			0.94			0.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5823	6	0	1	1	1	H5823_006_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				85.8	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5823	6	0	1	1	1	H5823_006_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				512.16	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	8	0	1	1	1	H5826_008_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	8	0	1	1	1	H5826_008_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								15	30	30					10	20	20					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	8	0	1	1	1	H5826_008_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								47	94	140					42	84	125					42	84	125																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	8	0	1	1	1	H5826_008_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31											107.27	50	50	50				107.27	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	8	0	1	1	1	H5826_008_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	9	0	1	1	1	H5826_009_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	9	0	1	1	1	H5826_009_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								15	30	30					10	20	20					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	9	0	1	1	1	H5826_009_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								47	94	140					42	84	125					42	84	125																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	9	0	1	1	1	H5826_009_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31											98.7	50	50	50				98.7	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	9	0	1	1	1	H5826_009_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	10	0	1	1	1	H5826_010_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	10	0	1	1	1	H5826_010_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								15	30	30					10	20	20					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	10	0	1	1	1	H5826_010_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								47	94	140					42	84	125					42	84	125																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	10	0	1	1	1	H5826_010_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31											88.74	50	50	50				88.74	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	10	0	1	1	1	H5826_010_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	16	0	1	1	1	H5826_016_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								5	10	10					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	16	0	1	1	1	H5826_016_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								15	30	30					10	20	20					10	20	20																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	16	0	1	1	1	H5826_016_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31								47	94	140					42	84	125					42	84	125																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	16	0	1	1	1	H5826_016_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	1	30	60	90				30		31											96.71	50	50	50				96.71	50	50	50				50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5826	16	0	1	1	1	H5826_016_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5841	1	0	1	4	1	H5841_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	1	0	1	4	1	H5841_001_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	1	0	1	4	1	H5841_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	1	0	1	4	1	H5841_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	1	0	1	4	1	H5841_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				737.41	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	1	0	1	4	1	H5841_001_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	1	0	1	4	1	H5841_001_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5841	2	0	1	4	1	H5841_002_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	2	0	1	4	1	H5841_002_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	2	0	1	4	1	H5841_002_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	2	0	1	4	1	H5841_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	2	0	1	4	1	H5841_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				757.14	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	2	0	1	4	1	H5841_002_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	2	0	1	4	1	H5841_002_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5841	3	0	1	4	1	H5841_003_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	3	0	1	4	1	H5841_003_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	3	0	1	4	1	H5841_003_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	3	0	1	4	1	H5841_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	3	0	1	4	1	H5841_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				762.59	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	3	0	1	4	1	H5841_003_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	3	0	1	4	1	H5841_003_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5841	4	0	1	4	1	H5841_004_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	4	0	1	4	1	H5841_004_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	4	0	1	4	1	H5841_004_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	4	0	1	4	1	H5841_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	4	0	1	4	1	H5841_004_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				744.59	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	4	0	1	4	1	H5841_004_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	4	0	1	4	1	H5841_004_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5841	5	0	1	4	1	H5841_005_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	5	0	1	4	1	H5841_005_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	5	0	1	4	1	H5841_005_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	5	0	1	4	1	H5841_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	5	0	1	4	1	H5841_005_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											768.26	33						768.26	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	5	0	1	4	1	H5841_005_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	5	0	1	4	1	H5841_005_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5841	7	0	1	4	1	H5841_007_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	4		8																			4		8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	7	0	1	4	1	H5841_007_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		20																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	7	0	1	4	1	H5841_007_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	7	0	1	4	1	H5841_007_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	7	0	1	4	1	H5841_007_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				711.94	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	7	0	1	4	1	H5841_007_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	7	0	1	4	1	H5841_007_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5841	8	0	1	4	1	H5841_008_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	4		8																			4		8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	8	0	1	4	1	H5841_008_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		20																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	8	0	1	4	1	H5841_008_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	8	0	1	4	1	H5841_008_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	8	0	1	4	1	H5841_008_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				707.36	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	8	0	1	4	1	H5841_008_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5841	8	0	1	4	1	H5841_008_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5852	1	0	1	1	1	H5852_001_0	4	Generic	4	1	1	1	1	1	110		1			1	30		90				1	2							30		34				16.22	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5852	1	0	1	1	1	H5852_001_0	4	Preferred Brand	4	11	1	1	2	1	110		1			1	30		90				1	2							30		34				97.42	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5852	1	0	1	1	1	H5852_001_0	4	Non-Preferred Brand	4	10	1	1	3	1	110		1			1	30		90				1	1							30		34				41.54	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5852	1	0	1	1	1	H5852_001_0	4	Specialty Tier	4	10	1	1	4	1	110		1			1	30		90				1	1							30		34				561.61	25		25																																			25			25								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5852	1	0	1	1	1	H5852_001_0	4	Select Care Drugs	4	1	1	1	5	1	110		1			1	30		90				1	2							30		34				0	0		0																																			0			0								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H5852	1	0	1	1	1	H5852_001_0	4	Select Care Drugs	4	1	1	1	5	3	110		1			1	30		90				1	2							30		34				0	0		0																																			0			0								"Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H5854	7	0	1	1	1	H5854_007_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	7	0	1	1	1	H5854_007_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	7	0	1	1	1	H5854_007_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								46	92	138					41	82	123					41	123	123																46				46			1.53	1.37	1.37			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	7	0	1	1	1	H5854_007_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	7	0	1	1	1	H5854_007_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	7	0	1	1	1	H5854_007_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	7	0	1	1	1	H5854_007_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	8	0	1	1	1	H5854_008_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	8	0	1	1	1	H5854_008_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	8	0	1	1	1	H5854_008_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					20	40	60					20	60	60																20				20			0.67	0.67	0.67			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	8	0	1	1	1	H5854_008_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	8	0	1	1	1	H5854_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	8	0	1	1	1	H5854_008_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	8	0	1	1	1	H5854_008_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	8	0	1	1	1	H5854_008_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	9	0	1	1	1	H5854_009_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	9	0	1	1	1	H5854_009_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	9	0	1	1	1	H5854_009_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	9	0	1	1	1	H5854_009_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	9	0	1	1	1	H5854_009_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	9	0	1	1	1	H5854_009_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	9	0	1	1	1	H5854_009_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	10	0	1	1	1	H5854_010_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	10	0	1	1	1	H5854_010_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								19	38	57					14	28	42					14	42	42																19				19			0.63	0.47	0.47			0.56	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	10	0	1	1	1	H5854_010_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								46	92	138					41	82	123					41	123	123																46				46			1.53	1.37	1.37			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	10	0	1	1	1	H5854_010_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	10	0	1	1	1	H5854_010_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	10	0	1	1	1	H5854_010_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	10	0	1	1	1	H5854_010_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	11	0	1	1	1	H5854_011_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	11	0	1	1	1	H5854_011_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	11	0	1	1	1	H5854_011_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								8	16	24					8	16	24					8	24	24																8				8			0.27	0.27	0.27			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	11	0	1	1	1	H5854_011_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	11	0	1	1	1	H5854_011_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	11	0	1	1	1	H5854_011_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	11	0	1	1	1	H5854_011_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	11	0	1	1	1	H5854_011_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	12	0	1	2	1	H5854_012_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	9	9																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	12	0	1	2	1	H5854_012_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					9	18	27					9	27	27																14				14			0.47	0.3	0.3			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	12	0	1	2	1	H5854_012_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	12	0	1	2	1	H5854_012_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	12	0	1	2	1	H5854_012_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	12	0	1	2	1	H5854_012_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	13	0	1	1	1	H5854_013_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	13	0	1	1	1	H5854_013_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	13	0	1	1	1	H5854_013_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								19	38	57					19	38	57					19	57	57																19				19			0.63	0.63	0.63			0.56	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	13	0	1	1	1	H5854_013_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	13	0	1	1	1	H5854_013_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	13	0	1	1	1	H5854_013_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	13	0	1	1	1	H5854_013_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	13	0	1	1	1	H5854_013_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	14	0	1	1	1	H5854_014_0	12	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	14	0	1	1	1	H5854_014_0	12	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	14	0	1	1	1	H5854_014_0	12	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	14	0	1	1	1	H5854_014_0	12	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		34	7.5	15	22.5																			7.5	15	15																7.5				7.5		0.25			0.25			0.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	14	0	1	1	1	H5854_014_0	12	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	40	80	120																			40	80	80																40				40		1.33			1.33			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	14	0	1	1	1	H5854_014_0	12	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		34	85	170	255																			85	170	170																85				85		2.83			2.83			2.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	14	0	1	1	1	H5854_014_0	12	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	14	0	1	1	1	H5854_014_0	12	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	14	0	1	1	1	H5854_014_0	12	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		34	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										2	3	
H5854	15	0	1	1	1	H5854_015_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	15	0	1	1	1	H5854_015_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5854	15	0	1	1	1	H5854_015_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								5	10	15					5	10	15					5	10	10																5				5			0.17	0.17	0.17			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	15	0	1	1	1	H5854_015_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	94	94																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	15	0	1	1	1	H5854_015_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	15	0	1	1	1	H5854_015_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	15	0	1	1	1	H5854_015_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5854	15	0	1	1	1	H5854_015_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5859	1	0	1	2	1	H5859_001_0	8	Generic	4	1	1	1	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				6.72	25	25	25																		24	24	24															25			25								"Generic, Brand"												
H5859	1	0	1	2	1	H5859_001_0	8	Brand	4	10	1	1	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				108.74	25	25	25																		24	24	24															25			25								"Generic, Brand"												
H5883	2	1	1	2	1	H5883_002_1	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	1	1	2	1	H5883_002_1	9	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	1	1	2	1	H5883_002_1	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	1	1	2	1	H5883_002_1	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											53	45		45				54	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	1	1	2	1	H5883_002_1	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	1	1	2	1	H5883_002_1	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	1	1	2	1	H5883_002_1	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	2	2	1	2	1	H5883_002_2	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	2	1	2	1	H5883_002_2	9	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	2	1	2	1	H5883_002_2	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	2	1	2	1	H5883_002_2	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											53	45		45				54	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	2	1	2	1	H5883_002_2	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	2	1	2	1	H5883_002_2	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	2	1	2	1	H5883_002_2	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	2	3	1	2	1	H5883_002_3	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	3	1	2	1	H5883_002_3	9	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	3	1	2	1	H5883_002_3	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	3	1	2	1	H5883_002_3	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											53	45		45				54	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	3	1	2	1	H5883_002_3	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	3	1	2	1	H5883_002_3	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	3	1	2	1	H5883_002_3	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	2	4	1	2	1	H5883_002_4	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	4	1	2	1	H5883_002_4	9	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	4	1	2	1	H5883_002_4	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	4	1	2	1	H5883_002_4	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											53	45		45				54	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	4	1	2	1	H5883_002_4	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	4	1	2	1	H5883_002_4	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	4	1	2	1	H5883_002_4	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	2	7	1	2	1	H5883_002_7	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	7	1	2	1	H5883_002_7	9	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	7	1	2	1	H5883_002_7	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	7	1	2	1	H5883_002_7	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											53	45		45				54	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	7	1	2	1	H5883_002_7	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	7	1	2	1	H5883_002_7	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	2	7	1	2	1	H5883_002_7	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	3	1	1	2	1	H5883_003_1	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	1	1	2	1	H5883_003_1	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	1	1	2	1	H5883_003_1	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	1	1	2	1	H5883_003_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											66	45		45				62	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	1	1	2	1	H5883_003_1	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	1	1	2	1	H5883_003_1	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	1	1	2	1	H5883_003_1	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	3	2	1	2	1	H5883_003_2	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	2	1	2	1	H5883_003_2	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	2	1	2	1	H5883_003_2	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	2	1	2	1	H5883_003_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											66	45		45				62	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	2	1	2	1	H5883_003_2	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	2	1	2	1	H5883_003_2	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	2	1	2	1	H5883_003_2	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	3	3	1	2	1	H5883_003_3	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	3	1	2	1	H5883_003_3	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	3	1	2	1	H5883_003_3	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	3	1	2	1	H5883_003_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											66	45		45				62	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	3	1	2	1	H5883_003_3	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	3	1	2	1	H5883_003_3	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	3	1	2	1	H5883_003_3	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	3	4	1	2	1	H5883_003_4	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	4	1	2	1	H5883_003_4	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	4	1	2	1	H5883_003_4	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	4	1	2	1	H5883_003_4	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											66	45		45				62	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	4	1	2	1	H5883_003_4	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	4	1	2	1	H5883_003_4	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	4	1	2	1	H5883_003_4	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	3	5	1	2	1	H5883_003_5	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	5	1	2	1	H5883_003_5	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	5	1	2	1	H5883_003_5	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								43		129					38		114											43		129				38		114				43				43			1.39	1.23		1.39	1.23	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	5	1	2	1	H5883_003_5	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											66	45		45				62	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	5	1	2	1	H5883_003_5	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	5	1	2	1	H5883_003_5	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	3	5	1	2	1	H5883_003_5	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	4	1	1	2	1	H5883_004_1	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								9		27					3		9											9		27				3		9				9				9			0.29	0.1		0.29	0.1	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	1	1	2	1	H5883_004_1	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	1	1	2	1	H5883_004_1	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	1	1	2	1	H5883_004_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											99	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	1	1	2	1	H5883_004_1	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	1	1	2	1	H5883_004_1	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	1	1	2	1	H5883_004_1	6	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	4	2	1	2	1	H5883_004_2	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								9		27					3		9											9		27				3		9				9				9			0.29	0.1		0.29	0.1	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	2	1	2	1	H5883_004_2	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	2	1	2	1	H5883_004_2	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	2	1	2	1	H5883_004_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											99	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	2	1	2	1	H5883_004_2	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	2	1	2	1	H5883_004_2	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	2	1	2	1	H5883_004_2	6	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	4	3	1	2	1	H5883_004_3	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								9		27					3		9											9		27				3		9				9				9			0.29	0.1		0.29	0.1	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	3	1	2	1	H5883_004_3	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	3	1	2	1	H5883_004_3	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	3	1	2	1	H5883_004_3	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											99	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	3	1	2	1	H5883_004_3	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	3	1	2	1	H5883_004_3	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	3	1	2	1	H5883_004_3	6	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	4	4	1	2	1	H5883_004_4	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								9		27					3		9											9		27				3		9				9				9			0.29	0.1		0.29	0.1	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	4	1	2	1	H5883_004_4	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	4	1	2	1	H5883_004_4	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	4	1	2	1	H5883_004_4	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											99	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	4	1	2	1	H5883_004_4	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	4	1	2	1	H5883_004_4	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	4	1	2	1	H5883_004_4	6	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	4	5	1	2	1	H5883_004_5	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								9		27					3		9											9		27				3		9				9				9			0.29	0.1		0.29	0.1	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	5	1	2	1	H5883_004_5	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	5	1	2	1	H5883_004_5	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	5	1	2	1	H5883_004_5	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											99	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	5	1	2	1	H5883_004_5	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	5	1	2	1	H5883_004_5	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	4	5	1	2	1	H5883_004_5	6	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	7	0	1	1	1	H5883_007_0	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	7	0	1	1	1	H5883_007_0	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	7	0	1	1	1	H5883_007_0	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	7	0	1	1	1	H5883_007_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											52	48		48				57	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	7	0	1	1	1	H5883_007_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	7	0	1	1	1	H5883_007_0	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	7	0	1	1	1	H5883_007_0	6	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	8	1	1	1	1	H5883_008_1	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	1	1	1	1	H5883_008_1	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	1	1	1	1	H5883_008_1	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	1	1	1	1	H5883_008_1	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											72	48		48				49	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	1	1	1	1	H5883_008_1	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	1	1	1	1	H5883_008_1	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	2	1	1	1	H5883_008_2	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	2	1	1	1	H5883_008_2	6	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	2	1	1	1	H5883_008_2	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	2	1	1	1	H5883_008_2	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											72	48		48				49	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	2	1	1	1	H5883_008_2	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	8	2	1	1	1	H5883_008_2	6	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	1	1	1	1	H5883_009_1	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	1	1	1	1	H5883_009_1	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	1	1	1	1	H5883_009_1	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	1	1	1	1	H5883_009_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											83	50		50				79	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	1	1	1	1	H5883_009_1	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	1	1	1	1	H5883_009_1	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	1	1	1	1	H5883_009_1	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	9	2	1	1	1	H5883_009_2	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	2	1	1	1	H5883_009_2	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	2	1	1	1	H5883_009_2	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	2	1	1	1	H5883_009_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											83	50		50				79	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	2	1	1	1	H5883_009_2	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	2	1	1	1	H5883_009_2	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	2	1	1	1	H5883_009_2	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	9	3	1	1	1	H5883_009_3	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	3	1	1	1	H5883_009_3	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	3	1	1	1	H5883_009_3	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	3	1	1	1	H5883_009_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											83	50		50				79	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	3	1	1	1	H5883_009_3	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	3	1	1	1	H5883_009_3	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	9	3	1	1	1	H5883_009_3	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	11	1	1	1	1	H5883_011_1	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	1	1	1	1	H5883_011_1	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	1	1	1	1	H5883_011_1	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	1	1	1	1	H5883_011_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											100	50		50				93	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	1	1	1	1	H5883_011_1	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	28						1	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	1	1	1	1	H5883_011_1	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	1	1	1	1	H5883_011_1	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	11	2	1	1	1	H5883_011_2	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	2	1	1	1	H5883_011_2	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	2	1	1	1	H5883_011_2	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	2	1	1	1	H5883_011_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											100	50		50				93	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	2	1	1	1	H5883_011_2	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	28						1	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	2	1	1	1	H5883_011_2	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	2	1	1	1	H5883_011_2	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5883	11	3	1	1	1	H5883_011_3	7	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	3	1	1	1	H5883_011_3	7	Generic	4	11	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	3	1	1	1	H5883_011_3	7	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	3	1	1	1	H5883_011_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											100	50		50				93	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	3	1	1	1	H5883_011_3	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	28						1	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	3	1	1	1	H5883_011_3	7	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5883	11	3	1	1	1	H5883_011_3	7	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5926	1	0	1	1	1	H5926_001_0	8	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5926	1	0	1	1	1	H5926_001_0	8	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5926	1	0	1	1	1	H5926_001_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	42	84	126																			42	84	126																42				42		1.35			1.35			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5926	1	0	1	1	1	H5926_001_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				98.45	42	42	42																		42	42	42															42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5926	1	0	1	1	1	H5926_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				488.97	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	1	0	1	1	1	H5928_001_0	5	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	1	0	1	1	1	H5928_001_0	5	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	1	0	1	1	1	H5928_001_0	5	Generic	4	1	1	1	2	1	111		1	100		1	30	60	90				2	2			90				30		31				3.55	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	1	0	1	1	1	H5928_001_0	5	Preferred Brand	4	11	1	1	3	1	111		1	100		1	30	60	90				2	2			90				30		31				76.42	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	1	0	1	1	1	H5928_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				2	2			90				30		31				40.42	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	1	0	1	1	1	H5928_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				462.16	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	4	0	1	1	1	H5928_004_0	5	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	4	0	1	1	1	H5928_004_0	5	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								5	5	5					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	4	0	1	1	1	H5928_004_0	5	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								10	20	25					3	6	7.5							7.5																10				10			0.33	0.1				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	4	0	1	1	1	H5928_004_0	5	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								10	20	25					3	6	7.5							7.5																10				10			0.33	0.1				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	4	0	1	1	1	H5928_004_0	5	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	4	0	1	1	1	H5928_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								87	174	217.5					80	160	200							200																87				87			2.9	2.67				2.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	4	0	1	1	1	H5928_004_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	5	0	1	1	1	H5928_005_0	5	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	5	0	1	1	1	H5928_005_0	5	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	5	0	1	1	1	H5928_005_0	5	Generic	4	1	1	1	2	1	111		1	100		1	30	60	90				2	2			90				30		31				3.77	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	5	0	1	1	1	H5928_005_0	5	Preferred Brand	4	11	1	1	3	1	111		1	100		1	30	60	90				2	2			90				30		31				80.9	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	5	0	1	1	1	H5928_005_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				2	2			90				30		31				42.66	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	5	0	1	1	1	H5928_005_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				488.86	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	9	0	1	1	1	H5928_009_0	6	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	9	0	1	1	1	H5928_009_0	6	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	9	0	1	1	1	H5928_009_0	6	Generic	4	1	1	1	2	1	111		1	100		1	30	60	90				2	2			90				30		31				3.67	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	9	0	1	1	1	H5928_009_0	6	Preferred Brand	4	11	1	1	3	1	111		1	100		1	30	60	90				2	2			90				30		31				76.3	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	9	0	1	1	1	H5928_009_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				2	2			90				30		31				39.24	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	9	0	1	1	1	H5928_009_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				461.04	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	10	0	1	1	1	H5928_010_0	5	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	10	0	1	1	1	H5928_010_0	5	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	10	0	1	1	1	H5928_010_0	5	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								10	20	25					5	10	12.5							12.5																10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	10	0	1	1	1	H5928_010_0	5	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								10	20	25					5	10	12.5							12.5																10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	10	0	1	1	1	H5928_010_0	5	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	10	0	1	1	1	H5928_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								95	190	237.5					88	176	220							220																95				95			3.17	2.93				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	10	0	1	1	1	H5928_010_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	16	0	1	1	1	H5928_016_0	5	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	16	0	1	1	1	H5928_016_0	5	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	16	0	1	1	1	H5928_016_0	5	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								12	24	30					5	10	12.5							12.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	16	0	1	1	1	H5928_016_0	5	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								12	24	30					5	10	12.5							12.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	16	0	1	1	1	H5928_016_0	5	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	16	0	1	1	1	H5928_016_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								87	174	217.5					80	160	200							200																87				87			2.9	2.67				2.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	16	0	1	1	1	H5928_016_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	37	0	1	1	1	H5928_037_0	5	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	37	0	1	1	1	H5928_037_0	5	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	37	0	1	1	1	H5928_037_0	5	Generic	4	1	1	1	2	1	111		1	100		1	30	60	90				2	2			90				30		31				3.66	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	37	0	1	1	1	H5928_037_0	5	Preferred Brand	4	11	1	1	3	1	111		1	100		1	30	60	90				2	2			90				30		31				78.22	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	37	0	1	1	1	H5928_037_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				2	2			90				30		31				41.57	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	37	0	1	1	1	H5928_037_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				475.93	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	44	0	1	1	1	H5928_044_0	4	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	44	0	1	1	1	H5928_044_0	4	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	44	0	1	1	1	H5928_044_0	4	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								12	24	30					5	10	12.5							12.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	44	0	1	1	1	H5928_044_0	4	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								12	24	30					5	10	12.5							12.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	44	0	1	1	1	H5928_044_0	4	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	44	0	1	1	1	H5928_044_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								87	174	217.5					80	160	200							200																87				87			2.9	2.67				2.81	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	44	0	1	1	1	H5928_044_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	50	0	1	1	1	H5928_050_0	4	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	50	0	1	1	1	H5928_050_0	4	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	50	0	1	1	1	H5928_050_0	4	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								12	24	30					5	10	12.5							12.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	50	0	1	1	1	H5928_050_0	4	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								12	24	30					5	10	12.5							12.5																12				12			0.4	0.17				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	50	0	1	1	1	H5928_050_0	4	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	50	0	1	1	1	H5928_050_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	250					90	180	225							225																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	50	0	1	1	1	H5928_050_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											546.89	29						546.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	51	0	1	1	1	H5928_051_0	4	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	51	0	1	1	1	H5928_051_0	4	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	51	0	1	1	1	H5928_051_0	4	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								17	34	42.5					10	20	25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	51	0	1	1	1	H5928_051_0	4	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								17	34	42.5					10	20	25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	51	0	1	1	1	H5928_051_0	4	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	51	0	1	1	1	H5928_051_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	250					90	180	225							225																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	51	0	1	1	1	H5928_051_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	52	0	1	1	1	H5928_052_0	4	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	52	0	1	1	1	H5928_052_0	4	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	52	0	1	1	1	H5928_052_0	4	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								17	34	42.5					10	20	25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	52	0	1	1	1	H5928_052_0	4	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								17	34	42.5					10	20	25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	52	0	1	1	1	H5928_052_0	4	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	52	0	1	1	1	H5928_052_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	250					90	180	225							225																100				100			3.33	3				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	52	0	1	1	1	H5928_052_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	53	0	1	1	1	H5928_053_0	6	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	53	0	1	1	1	H5928_053_0	6	Preferred Generic	4	1	1	2	1	3		111	1	100		1				30	60	90	2	2			90				30		31								3	3	3					0	0	0							0																3				3			0.1	0				0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	53	0	1	1	1	H5928_053_0	6	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								17	34	42.5					10	20	25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	53	0	1	1	1	H5928_053_0	6	Generic	4	1	1	2	2	3		111	1	100		1				30	60	90	2	2			90				30		31								17	34	42.5					10	20	25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	53	0	1	1	1	H5928_053_0	6	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	117.5					40	80	100							100																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	53	0	1	1	1	H5928_053_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	90	2	2			90				30		31								100	200	250					95	190	237.5							237.5																100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	53	0	1	1	1	H5928_053_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	54	0	1	1	1	H5928_054_0	4	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	54	0	1	1	1	H5928_054_0	4	Preferred Generic	4	1	1	2	1	3	111		1	100		1	30	60	90				2	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H5928	54	0	1	1	1	H5928_054_0	4	Generic	4	1	1	1	2	1	111		1	100		1	30	60	90				2	2			90				30		31				3.66	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	54	0	1	1	1	H5928_054_0	4	Preferred Brand	4	11	1	1	3	1	111		1	100		1	30	60	90				2	2			90				30		31				78.43	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	54	0	1	1	1	H5928_054_0	4	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				2	2			90				30		31				41.36	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5928	54	0	1	1	1	H5928_054_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				474.03	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	1	0	1	1	1	H5932_001_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	1	0	1	1	1	H5932_001_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	1	0	1	1	1	H5932_001_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	1	0	1	1	1	H5932_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				98.81	44	44	44																		44	44	44															44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	1	0	1	1	1	H5932_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				441.88	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	9	0	1	1	1	H5932_009_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	9	0	1	1	1	H5932_009_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	9	0	1	1	1	H5932_009_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	9	0	1	1	1	H5932_009_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				93.78	44	44	44																		44	44	44															44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5932	9	0	1	1	1	H5932_009_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				485.89	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5938	1	0	1	1	1	H5938_001_0	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	9																			3	6	0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	1	0	1	1	1	H5938_001_0	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	9																			3	6	0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5938	1	0	1	1	1	H5938_001_0	8	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	17.5																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	1	0	1	1	1	H5938_001_0	8	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	17.5																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5938	1	0	1	1	1	H5938_001_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	1	0	1	1	1	H5938_001_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	237.5																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	1	0	1	1	1	H5938_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					30																																					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	6	0	1	1	1	H5938_006_0	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	9																			3	6	0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	6	0	1	1	1	H5938_006_0	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	9																			3	6	0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5938	6	0	1	1	1	H5938_006_0	8	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	17.5																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	6	0	1	1	1	H5938_006_0	8	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	17.5																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H5938	6	0	1	1	1	H5938_006_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	6	0	1	1	1	H5938_006_0	8	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	237.5																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5938	6	0	1	1	1	H5938_006_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					30																																					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H5943	1	0	1	2	1	H5943_001_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	1	0	1	2	1	H5943_001_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	9																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	1	0	1	2	1	H5943_001_0	7	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											86.33	25	25	25				86.33	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	1	0	1	2	1	H5943_001_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											85.59	25	25	25				85.59	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	1	0	1	2	1	H5943_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	2	0	1	2	1	H5943_002_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								3	6	9					0	0	0					0	0	0																3				3			0.1	0	0			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	2	0	1	2	1	H5943_002_0	8	Generic	4	11	1	1	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											5.73	25	25	25				5.73	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	2	0	1	2	1	H5943_002_0	8	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											92.99	25	25	25				92.99	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	2	0	1	2	1	H5943_002_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											132.47	25	25	25				132.47	25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5943	2	0	1	2	1	H5943_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5945	1	0	1	1	1	H5945_001_0	15	Preferred Generic	4	11	3	2	1	1	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	1	0	1	1	1	H5945_001_0	15	Preferred Generic	4	11	3	2	1	3	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		2
H5945	1	0	1	1	1	H5945_001_0	15	Generic	4	11	1	2	2	1	111		1	100		1	30	60	100				1	2			100				30		31	16	32	32																					32																16				16		0.53						0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	1	0	1	1	1	H5945_001_0	15	Generic	4	11	1	2	2	3	111		1	100		1	30	60	100				1	2			100				30		31	16	32	32																					32																16				16		0.53						0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5945	1	0	1	1	1	H5945_001_0	15	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	100				1	2			100				30		31	40	80	120																					120																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	1	0	1	1	1	H5945_001_0	15	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	100				1	2			100				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	1	0	1	1	1	H5945_001_0	15	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	1	0	1	1	1	H5945_001_0	15	Select Care Drugs	4	11	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	1	0	1	1	1	H5945_001_0	15	Select Care Drugs	4	11	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5945	2	0	1	1	1	H5945_002_0	15	Preferred Generic	4	11	3	2	1	1	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	2	0	1	1	1	H5945_002_0	15	Preferred Generic	4	11	3	2	1	3	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		2
H5945	2	0	1	1	1	H5945_002_0	15	Generic	4	11	1	2	2	1	111		1	100		1	30	60	100				1	2			100				30		31	16	32	32																					32																16				16		0.53						0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	2	0	1	1	1	H5945_002_0	15	Generic	4	11	1	2	2	3	111		1	100		1	30	60	100				1	2			100				30		31	16	32	32																					32																16				16		0.53						0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5945	2	0	1	1	1	H5945_002_0	15	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	100				1	2			100				30		31	40	80	120																					120																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	2	0	1	1	1	H5945_002_0	15	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	100				1	2			100				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	2	0	1	1	1	H5945_002_0	15	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	2	0	1	1	1	H5945_002_0	15	Select Care Drugs	4	11	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5945	2	0	1	1	1	H5945_002_0	15	Select Care Drugs	4	11	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H5959	9	0	1	4	1	H5959_009_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								15	30	30					5	10	10					5	0	0																15				15			0.48	0.16	0.16			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	9	0	1	4	1	H5959_009_0	3	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								20	40	40					10	20	20					10	20	20																20				20			0.65	0.32	0.32			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	9	0	1	4	1	H5959_009_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								47	94	94					37	74	74					37	74	74																47				47			1.52	1.19	1.19			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	9	0	1	4	1	H5959_009_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											81.6	50	50	50				98.15	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	9	0	1	4	1	H5959_009_0	3	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	9	0	1	4	1	H5959_009_0	3	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					5	0	0																5				5			0.16	0	0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	1	1	4	1	H5959_010_1	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								13	26	26					3	6	6					3	0	0																13				13			0.42	0.1	0.1			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	1	1	4	1	H5959_010_1	3	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								19	38	38					9	18	18					9	18	18																19				19			0.61	0.29	0.29			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	1	1	4	1	H5959_010_1	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								47	94	94					37	74	74					37	74	74																47				47			1.52	1.19	1.19			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	1	1	4	1	H5959_010_1	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											95.25	50	50	50				58.89	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	1	1	4	1	H5959_010_1	3	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	1	1	4	1	H5959_010_1	3	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					3	0	0																5				5			0.16	0	0.1			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	2	1	4	1	H5959_010_2	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								13	26	26					3	6	6					3	0	0																13				13			0.42	0.1	0.1			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	2	1	4	1	H5959_010_2	3	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								19	38	38					9	18	18					9	18	18																19				19			0.61	0.29	0.29			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	2	1	4	1	H5959_010_2	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								47	94	94					37	74	74					37	74	74																47				47			1.52	1.19	1.19			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	2	1	4	1	H5959_010_2	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											95.25	50	50	50				58.89	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	2	1	4	1	H5959_010_2	3	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	10	2	1	4	1	H5959_010_2	3	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					3	0	0																5				5			0.16	0	0.1			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	11	0	1	4	1	H5959_011_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								13	26	26					3	6	6					3	0	0																13				13			0.42	0.1	0.1			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	11	0	1	4	1	H5959_011_0	3	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								19	38	38					9	18	18					9	18	18																19				19			0.61	0.29	0.29			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	11	0	1	4	1	H5959_011_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								47	94	94					37	74	74					37	74	74																47				47			1.52	1.19	1.19			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	11	0	1	4	1	H5959_011_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											96.76	50	50	50				60.09	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	11	0	1	4	1	H5959_011_0	3	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	11	0	1	4	1	H5959_011_0	3	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					3	0	0																5				5			0.16	0	0.1			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	12	0	1	4	1	H5959_012_0	4	Preferred Generic	2	1	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	6	12	12																			6	0	0																6				6		0.19			0.19			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	12	0	1	4	1	H5959_012_0	4	Generic	2	1	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	12	24	24																			12	24	24																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	12	0	1	4	1	H5959_012_0	4	Preferred Brand	2	11	1	1	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				55.88	21	21	21																		21	21	21															21			21								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	12	0	1	4	1	H5959_012_0	4	Non-Preferred Drug	2	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				91.77	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	12	0	1	4	1	H5959_012_0	4	Specialty Tier	2	11	1	1	5	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	12	0	1	4	1	H5959_012_0	4	Select Care Drugs	2	1	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			6	0	0																0				0		0			0.19			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	1	1	4	1	H5959_013_1	4	Preferred Generic	2	1	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	6	12	12																			6	0	0																6				6		0.19			0.19			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	1	1	4	1	H5959_013_1	4	Generic	2	1	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	12	24	24																			12	24	24																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	1	1	4	1	H5959_013_1	4	Preferred Brand	2	11	1	1	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				55.38	21	21	21																		21	21	21															21			21								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	1	1	4	1	H5959_013_1	4	Non-Preferred Drug	2	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				88.93	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	1	1	4	1	H5959_013_1	4	Specialty Tier	2	11	1	1	5	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	1	1	4	1	H5959_013_1	4	Select Care Drugs	2	1	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			6	0	0																0				0		0			0.19			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	2	1	4	1	H5959_013_2	5	Preferred Generic	2	1	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	6	12	12																			6	0	0																6				6		0.19			0.19			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	2	1	4	1	H5959_013_2	5	Generic	2	1	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	12	24	24																			12	24	24																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	2	1	4	1	H5959_013_2	5	Preferred Brand	2	11	1	1	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				55.38	21	21	21																		21	21	21															21			21								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	2	1	4	1	H5959_013_2	5	Non-Preferred Drug	2	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				88.93	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	2	1	4	1	H5959_013_2	5	Specialty Tier	2	11	1	1	5	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	13	2	1	4	1	H5959_013_2	5	Select Care Drugs	2	1	1	2	6	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			6	0	0																0				0		0			0.19			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	1	1	4	1	H5959_014_1	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								15	30	30					5	10	10					5	0	0																15				15			0.48	0.16	0.16			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	1	1	4	1	H5959_014_1	3	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								20	40	40					10	20	20					10	20	20																20				20			0.65	0.32	0.32			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	1	1	4	1	H5959_014_1	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								47	94	94					37	74	74					37	74	74																47				47			1.52	1.19	1.19			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	1	1	4	1	H5959_014_1	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											72.18	50	50	50				87.59	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	1	1	4	1	H5959_014_1	3	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	1	1	4	1	H5959_014_1	3	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					5	0	0																5				5			0.16	0	0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	2	1	4	1	H5959_014_2	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								15	30	30					5	10	10					5	0	0																15				15			0.48	0.16	0.16			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	2	1	4	1	H5959_014_2	3	Generic	4	1	1	2	2	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								20	40	40					10	20	20					10	20	20																20				20			0.65	0.32	0.32			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	2	1	4	1	H5959_014_2	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								47	94	94					37	74	74					37	74	74																47				47			1.52	1.19	1.19			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	2	1	4	1	H5959_014_2	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31											72.18	50	50	50				87.59	45	45	45				45	45	45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	2	1	4	1	H5959_014_2	3	Specialty Tier	4	11	1	1	5	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5959	14	2	1	4	1	H5959_014_2	3	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				31	60	90	1	2	31	60	90				31		31								5	10	10					0	0	0					5	0	0																5				5			0.16	0	0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H5965	1	0	1	4	1	H5965_001_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	1	0	1	4	1	H5965_001_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	1	0	1	4	1	H5965_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	1	0	1	4	1	H5965_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	1	0	1	4	1	H5965_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	2	0	1	4	1	H5965_002_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	2	0	1	4	1	H5965_002_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	2	0	1	4	1	H5965_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	2	0	1	4	1	H5965_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5965	2	0	1	4	1	H5965_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					27																										27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	1	0	1	4	1	H5970_001_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	1	0	1	4	1	H5970_001_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	1	0	1	4	1	H5970_001_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	1	0	1	4	1	H5970_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	1	0	1	4	1	H5970_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	15	0	1	4	1	H5970_015_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	15	0	1	4	1	H5970_015_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	15	0	1	4	1	H5970_015_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	15	0	1	4	1	H5970_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	15	0	1	4	1	H5970_015_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	18	0	1	4	1	H5970_018_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	18	0	1	4	1	H5970_018_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	18	0	1	4	1	H5970_018_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	18	0	1	4	1	H5970_018_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	18	0	1	4	1	H5970_018_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	19	0	1	4	1	H5970_019_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	19	0	1	4	1	H5970_019_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	19	0	1	4	1	H5970_019_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	19	0	1	4	1	H5970_019_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	19	0	1	4	1	H5970_019_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	20	0	1	4	1	H5970_020_0	5	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	20	0	1	4	1	H5970_020_0	5	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	20	0	1	4	1	H5970_020_0	5	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	20	0	1	4	1	H5970_020_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	20	0	1	4	1	H5970_020_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	21	0	1	4	1	H5970_021_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	21	0	1	4	1	H5970_021_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	21	0	1	4	1	H5970_021_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	21	0	1	4	1	H5970_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	21	0	1	4	1	H5970_021_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	22	0	1	4	1	H5970_022_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	22	0	1	4	1	H5970_022_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	22	0	1	4	1	H5970_022_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	22	0	1	4	1	H5970_022_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	22	0	1	4	1	H5970_022_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	23	0	1	4	1	H5970_023_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	23	0	1	4	1	H5970_023_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	23	0	1	4	1	H5970_023_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	23	0	1	4	1	H5970_023_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5970	23	0	1	4	1	H5970_023_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5989	2	0	1	1	1	H5989_002_0	4	Generic	3	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	5.25		15.75																					15.75																5.25				5.25		0.18						0.17	"Generic, Brand"												
H5989	2	0	1	1	1	H5989_002_0	4	Brand	3	10	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31				54.29	25		25																				25															25			25								"Generic, Brand"												
H5991	3	0	1	1	1	H5991_003_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	3	0	1	1	1	H5991_003_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	3	0	1	1	1	H5991_003_0	6	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	3	0	1	1	1	H5991_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	3	0	1	1	1	H5991_003_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											594.04	27						594.04	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	6	0	1	1	1	H5991_006_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	6	0	1	1	1	H5991_006_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					18	36	54					18	36	45																20				20			0.67	0.6	0.6			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	6	0	1	1	1	H5991_006_0	3	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	6	0	1	1	1	H5991_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H5991	6	0	1	1	1	H5991_006_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											552.78	27						552.78	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6080	1	0	1	48	5	H6080_001_0	4	Generic Drugs	4	1			1	1	110		1	100		1	30		90				2	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6	0	3.6			0	3.6			
H6080	1	0	1	48	5	H6080_001_0	4	Brand Drugs	4	10			2	1	110		1	100		1	30		90				2	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95	0	8.95			0	8.95			
H6080	1	0	1	48	5	H6080_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		1	100		1	30		90				1	1			90				30		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H6121	3	0	1	1	1	H6121_003_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																0				0			0.27	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6121	3	0	1	1	1	H6121_003_0	6	Generic	4	11	1	1	2	1		110	1	110		1				30		90	1	2	30		90				30		31											10.74	25		25				10.74	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6121	3	0	1	1	1	H6121_003_0	6	Preferred Brand	4	11	1	1	3	1		110	1	110		1				30		90	1	2	30		90				30		31											60.88	25		25				60.88	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6121	3	0	1	1	1	H6121_003_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											76.96	25		25				76.96	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6121	3	0	1	1	1	H6121_003_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											675.83	25						675.83	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6121	3	0	1	1	1	H6121_003_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6121	3	0	1	1	1	H6121_003_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H6154	1	0	1	2	1	H6154_001_0	11	Preferred Generic	3	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		45					4		12							0																15				15			0.5	0.13				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	1	0	1	2	1	H6154_001_0	11	Generic	3	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	1	0	1	2	1	H6154_001_0	11	Preferred Brand	3	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					41		123							113																47				47			1.57	1.37				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	1	0	1	2	1	H6154_001_0	11	Non-Preferred Drug	3	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											90.66	50		50				82.16	45		45						45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	1	0	1	2	1	H6154_001_0	11	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	2	0	1	2	1	H6154_002_0	10	Preferred Generic	3	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		45					8		24							0																15				15			0.5	0.27				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	2	0	1	2	1	H6154_002_0	10	Generic	3	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	2	0	1	2	1	H6154_002_0	10	Preferred Brand	3	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					40		120							110																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	2	0	1	2	1	H6154_002_0	10	Non-Preferred Drug	3	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											94.72	50		50				90.4	45		45						45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	2	0	1	2	1	H6154_002_0	10	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	3	0	1	1	1	H6154_003_0	2	Preferred Generic	3	11	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					15																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	3	0	1	1	1	H6154_003_0	2	Generic	3	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	12		36																					36																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	3	0	1	1	1	H6154_003_0	2	Preferred Brand	3	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					135																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	3	0	1	1	1	H6154_003_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		31				41.65	50		50																				50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	3	0	1	1	1	H6154_003_0	2	Specialty Tier	3	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	4	0	1	1	1	H6154_004_0	2	Preferred Generic	3	11	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	5		15																					15																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	4	0	1	1	1	H6154_004_0	2	Generic	3	11	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	13		39																					39																13				13		0.43						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	4	0	1	1	1	H6154_004_0	2	Preferred Brand	3	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	46		138																					138																46				46		1.53						1.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	4	0	1	1	1	H6154_004_0	2	Non-Preferred Drug	3	11	1	1	4	1	110		1	100		1	30		90				1	2			90				30		31				43.22	50		50																				50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6154	4	0	1	1	1	H6154_004_0	2	Specialty Tier	3	11	1	1	5	1	110		1	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6229	5	0	1	48	5	H6229_005_0	5	Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H6229	5	0	1	48	5	H6229_005_0	5	Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H6229	5	0	1	48	5	H6229_005_0	5	Non-Medicare Rx Drugs	4	11			3	1	10		10			1	31															10	34																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0			0	0			
H6229	5	0	1	48	5	H6229_005_0	5	Non-Medicare OTC Drugs	4	11			4	1	10		10			1	31															10	34																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0			0	0			
H6229	6	0	1	48	5	H6229_006_0	4	Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H6229	6	0	1	48	5	H6229_006_0	4	Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	8.95			0	8.95	0	8.95			
H6229	6	0	1	48	5	H6229_006_0	4	Non-Medicare Rx Drugs	4	11			3	1	10		10			1	31															10	34																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0			0	0			
H6229	6	0	1	48	5	H6229_006_0	4	Non-Medicare OTC Drugs	4	11			4	1	10		10			1	31															10	34																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0			0	0			
H6237	7	1	1	1	1	H6237_007_1	10	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	1	1	1	1	H6237_007_1	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	1	1	1	1	H6237_007_1	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	1	1	1	1	H6237_007_1	10	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	1	1	1	1	H6237_007_1	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											749.89	29						749.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	2	1	1	1	H6237_007_2	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	2	1	1	1	H6237_007_2	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	2	1	1	1	H6237_007_2	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	2	1	1	1	H6237_007_2	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	2	1	1	1	H6237_007_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											749.89	29						749.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	3	1	1	1	H6237_007_3	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	3	1	1	1	H6237_007_3	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								19	38	38					12	24	24					12	24	24																19				19			0.63	0.4	0.4			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	3	1	1	1	H6237_007_3	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	3	1	1	1	H6237_007_3	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	7	3	1	1	1	H6237_007_3	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											749.89	29						749.89	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	1	1	1	1	H6237_008_1	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	1	1	1	1	H6237_008_1	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	1	1	1	1	H6237_008_1	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	1	1	1	1	H6237_008_1	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	1	1	1	1	H6237_008_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											801.61	31						801.61	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	2	1	1	1	H6237_008_2	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	2	1	1	1	H6237_008_2	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	2	1	1	1	H6237_008_2	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	2	1	1	1	H6237_008_2	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	2	1	1	1	H6237_008_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											801.61	31						801.61	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	3	1	1	1	H6237_008_3	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	3	1	1	1	H6237_008_3	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								15	30	30					8	16	16					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	3	1	1	1	H6237_008_3	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	3	1	1	1	H6237_008_3	11	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	100	1	2	30	60	100				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6237	8	3	1	1	1	H6237_008_3	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											801.61	31						801.61	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6306	5	0	1	1	1	H6306_005_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	5	0	1	1	1	H6306_005_0	3	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	5	0	1	1	1	H6306_005_0	3	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	5	0	1	1	1	H6306_005_0	3	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	5	0	1	1	1	H6306_005_0	3	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	5	0	1	1	1	H6306_005_0	3	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				750	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	5	0	1	1	1	H6306_005_0	3	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	10	0																			10	10	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	5	0	1	1	1	H6306_005_0	3	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	10	0																			10	10	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	10	0	1	1	1	H6306_010_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	0	0																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	10	0	1	1	1	H6306_010_0	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	8	12																			4	0	0																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	10	0	1	1	1	H6306_010_0	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	37.5																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	10	0	1	1	1	H6306_010_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	117.5																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	10	0	1	1	1	H6306_010_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	10	0	1	1	1	H6306_010_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				360	29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	10	0	1	1	1	H6306_010_0	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	4	0																			4	4	0																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	10	0	1	1	1	H6306_010_0	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4	4	0																			4	4	0																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	11	1	1	1	1	H6306_011_1	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	1	1	1	1	H6306_011_1	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	11	1	1	1	1	H6306_011_1	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	18	36	54																			18	36	45																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	1	1	1	1	H6306_011_1	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	1	1	1	1	H6306_011_1	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	1	1	1	1	H6306_011_1	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				410	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	1	1	1	1	H6306_011_1	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	6	0																			6	6	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	1	1	1	1	H6306_011_1	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	6	0																			6	6	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	11	2	1	1	1	H6306_011_2	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	2	1	1	1	H6306_011_2	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	11	2	1	1	1	H6306_011_2	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	18	36	54																			18	36	45																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	2	1	1	1	H6306_011_2	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	2	1	1	1	H6306_011_2	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	2	1	1	1	H6306_011_2	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				410	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	2	1	1	1	H6306_011_2	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	6	0																			6	6	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	2	1	1	1	H6306_011_2	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	6	0																			6	6	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	11	3	1	1	1	H6306_011_3	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	3	1	1	1	H6306_011_3	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	12	18																			6	0	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	11	3	1	1	1	H6306_011_3	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	18	36	54																			18	36	45																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	3	1	1	1	H6306_011_3	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	3	1	1	1	H6306_011_3	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	3	1	1	1	H6306_011_3	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				410	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	3	1	1	1	H6306_011_3	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	6	0																			6	6	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	11	3	1	1	1	H6306_011_3	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	6	6	0																			6	6	0																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	12	1	1	1	1	H6306_012_1	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	0	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	1	1	1	1	H6306_012_1	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	0	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	12	1	1	1	1	H6306_012_1	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	50																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	1	1	1	1	H6306_012_1	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	1	1	1	1	H6306_012_1	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	1	1	1	1	H6306_012_1	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				310	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	1	1	1	1	H6306_012_1	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	10	0																			10	10	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	1	1	1	1	H6306_012_1	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	10	0																			10	10	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	12	4	1	1	1	H6306_012_4	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	0	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	4	1	1	1	H6306_012_4	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	0	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6306	12	4	1	1	1	H6306_012_4	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	50																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	4	1	1	1	H6306_012_4	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	4	1	1	1	H6306_012_4	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	4	1	1	1	H6306_012_4	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				310	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	4	1	1	1	H6306_012_4	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	10	0																			10	10	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H6306	12	4	1	1	1	H6306_012_4	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	10	0																			10	10	0																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H6316	1	0	1	1	1	H6316_001_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	1	0	1	1	1	H6316_001_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	1	0	1	1	1	H6316_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	1	0	1	1	1	H6316_001_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				81.31	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	1	0	1	1	1	H6316_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	2	0	1	1	1	H6316_002_0	4	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	2	0	1	1	1	H6316_002_0	4	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	2	0	1	1	1	H6316_002_0	4	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	2	0	1	1	1	H6316_002_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.95	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	2	0	1	1	1	H6316_002_0	4	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	3	0	1	1	1	H6316_003_0	4	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	3	0	1	1	1	H6316_003_0	4	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	3	0	1	1	1	H6316_003_0	4	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	3	0	1	1	1	H6316_003_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.95	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	3	0	1	1	1	H6316_003_0	4	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	4	0	1	1	1	H6316_004_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	4	0	1	1	1	H6316_004_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	4	0	1	1	1	H6316_004_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	4	0	1	1	1	H6316_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				78.48	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6316	4	0	1	1	1	H6316_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	1	0	1	4	1	H6328_001_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	1	0	1	4	1	H6328_001_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6328	1	0	1	4	1	H6328_001_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10	20	20																			10	20	20																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	1	0	1	4	1	H6328_001_0	5	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10	20	20																			10	20	20																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6328	1	0	1	4	1	H6328_001_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40	80	80																			40	80	80																	40			40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	1	0	1	4	1	H6328_001_0	5	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40	80	80																			40	80	80																	40			40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6328	1	0	1	4	1	H6328_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	85	170	170																			85	170	170																	85			85		2.83			2.83			2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	1	0	1	4	1	H6328_001_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1098.3	33	33	33																		33	33	33																33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	2	0	1	4	1	H6328_002_0	6	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	2	4	4																			2	4	4																	2			2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	2	0	1	4	1	H6328_002_0	6	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	2	4	4																			2	4	4																	2			2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6328	2	0	1	4	1	H6328_002_0	6	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12	24	24																			12	24	24																	12			12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	2	0	1	4	1	H6328_002_0	6	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12	24	24																			12	24	24																	12			12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6328	2	0	1	4	1	H6328_002_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45	90	90																			45	90	90																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	2	0	1	4	1	H6328_002_0	6	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45	90	90																			45	90	90																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6328	2	0	1	4	1	H6328_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90	180	180																			90	180	180																	90			90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	2	0	1	4	1	H6328_002_0	6	Specialty Tier	4	11	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	3	0	1	4	1	H6328_003_0	6	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5	10	10																			5	10	10																	5			5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	3	0	1	4	1	H6328_003_0	6	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5	10	10																			5	10	10																	5			5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6328	3	0	1	4	1	H6328_003_0	6	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15	30	30																			15	30	30																	15			15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	3	0	1	4	1	H6328_003_0	6	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15	30	30																			15	30	30																	15			15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6328	3	0	1	4	1	H6328_003_0	6	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	47	94	94																			47	94	94																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	3	0	1	4	1	H6328_003_0	6	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	47	94	94																			47	94	94																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6328	3	0	1	4	1	H6328_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	100	200	200																			100	200	200																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6328	3	0	1	4	1	H6328_003_0	6	Specialty Tier	4	11	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"												
H6348	1	0	1	4	1	H6348_001_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	1	0	1	4	1	H6348_001_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	15																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	1	0	1	4	1	H6348_001_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	1	0	1	4	1	H6348_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	1	0	1	4	1	H6348_001_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	1	0	1	4	1	H6348_001_0	5	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	2	0	1	4	1	H6348_002_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	2	0	1	4	1	H6348_002_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	15																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	2	0	1	4	1	H6348_002_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	2	0	1	4	1	H6348_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	2	0	1	4	1	H6348_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	2	0	1	4	1	H6348_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	3	0	1	4	1	H6348_003_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	3	0	1	4	1	H6348_003_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	45																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	3	0	1	4	1	H6348_003_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	3	0	1	4	1	H6348_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	3	0	1	4	1	H6348_003_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	3	0	1	4	1	H6348_003_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	4	0	1	4	1	H6348_004_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	4	0	1	4	1	H6348_004_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	15																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	4	0	1	4	1	H6348_004_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	4	0	1	4	1	H6348_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	4	0	1	4	1	H6348_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6348	4	0	1	4	1	H6348_004_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6351	2	0	1	1	1	H6351_002_0	4	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4	8	12																																						4			4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	2	0	1	1	1	H6351_002_0	4	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	2	0	1	1	1	H6351_002_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	2	0	1	1	1	H6351_002_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	2	0	1	1	1	H6351_002_0	4	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	3	0	1	1	1	H6351_003_0	4	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4	8	12																																						4			4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	3	0	1	1	1	H6351_003_0	4	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	3	0	1	1	1	H6351_003_0	4	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	3	0	1	1	1	H6351_003_0	4	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6351	3	0	1	1	1	H6351_003_0	4	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6379	1	0	1	1	1	H6379_001_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	2		0																			2		0																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6379	1	0	1	1	1	H6379_001_0	6	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6379	1	0	1	1	1	H6379_001_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		131																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6379	1	0	1	1	1	H6379_001_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	95		285																			95		275																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6379	1	0	1	1	1	H6379_001_0	6	Specialty Tier	4	11	1	1	5	1	110		1	10		1	30		90				2	2	30						30		31				50	31		31																		31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	1	0	1	1	1	H6396_001_0	7	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	1	0	1	1	1	H6396_001_0	7	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	1	0	1	1	1	H6396_001_0	7	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	1	0	1	1	1	H6396_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	1	0	1	1	1	H6396_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					32																																					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	4	0	1	1	1	H6396_004_0	8	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	5	10	15																					0																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	4	0	1	1	1	H6396_004_0	8	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	4	0	1	1	1	H6396_004_0	8	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	4	0	1	1	1	H6396_004_0	8	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6396	4	0	1	1	1	H6396_004_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					30																																					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	2	0	1	1	1	H6439_002_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	2	0	1	1	1	H6439_002_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	2	0	1	1	1	H6439_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	2	0	1	1	1	H6439_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	2	0	1	1	1	H6439_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	3	0	1	1	1	H6439_003_0	5	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	2		6																									2		6				2		0				2				2		0.07				0.07	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	3	0	1	1	1	H6439_003_0	5	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	18		54																									18		54				18		0				18				18		0.6				0.6	0.6	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	3	0	1	1	1	H6439_003_0	5	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	3	0	1	1	1	H6439_003_0	5	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.38	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	3	0	1	1	1	H6439_003_0	5	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	4	0	1	1	1	H6439_004_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	4	0	1	1	1	H6439_004_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	4	0	1	1	1	H6439_004_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	4	0	1	1	1	H6439_004_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				78.48	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6439	4	0	1	1	1	H6439_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6446	1	0	1	1	1	H6446_001_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6446	1	0	1	1	1	H6446_001_0	3	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H6446	1	0	1	1	1	H6446_001_0	3	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6446	1	0	1	1	1	H6446_001_0	3	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H6446	1	0	1	1	1	H6446_001_0	3	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6446	1	0	1	1	1	H6446_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6446	1	0	1	1	1	H6446_001_0	3	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6446	1	0	1	1	1	H6446_001_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6446	1	0	1	1	1	H6446_001_0	3	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H6453	5	0	1	1	1	H6453_005_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	5	0	1	1	1	H6453_005_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	5	0	1	1	1	H6453_005_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	5	0	1	1	1	H6453_005_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	5	0	1	1	1	H6453_005_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	5	0	1	1	1	H6453_005_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	5	0	1	1	1	H6453_005_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.43	33						476.7	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	6	0	1	1	1	H6453_006_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	6	0	1	1	1	H6453_006_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	6	0	1	1	1	H6453_006_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	6	0	1	1	1	H6453_006_0	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	6	0	1	1	1	H6453_006_0	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	6	0	1	1	1	H6453_006_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	6	0	1	1	1	H6453_006_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											725.1	33						479.37	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	1	1	1	1	H6453_007_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	1	1	1	1	H6453_007_1	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	7	1	1	1	1	H6453_007_1	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	1	1	1	1	H6453_007_1	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	7	1	1	1	1	H6453_007_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	1	1	1	1	H6453_007_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	1	1	1	1	H6453_007_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											722.26	33						475.92	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	2	1	1	1	H6453_007_2	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	2	1	1	1	H6453_007_2	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	7	2	1	1	1	H6453_007_2	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	2	1	1	1	H6453_007_2	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	7	2	1	1	1	H6453_007_2	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	2	1	1	1	H6453_007_2	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	7	2	1	1	1	H6453_007_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											722.26	33						475.92	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	1	1	1	1	H6453_008_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	1	1	1	1	H6453_008_1	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	8	1	1	1	1	H6453_008_1	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	1	1	1	1	H6453_008_1	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	8	1	1	1	1	H6453_008_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	1	1	1	1	H6453_008_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	1	1	1	1	H6453_008_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											719.03	33						472.67	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	2	1	1	1	H6453_008_2	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	2	1	1	1	H6453_008_2	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	8	2	1	1	1	H6453_008_2	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	2	1	1	1	H6453_008_2	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	8	2	1	1	1	H6453_008_2	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	2	1	1	1	H6453_008_2	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	8	2	1	1	1	H6453_008_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											719.03	33						472.67	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	1	1	1	1	H6453_009_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	1	1	1	1	H6453_009_1	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	9	1	1	1	1	H6453_009_1	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	1	1	1	1	H6453_009_1	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	9	1	1	1	1	H6453_009_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	1	1	1	1	H6453_009_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	1	1	1	1	H6453_009_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											720.34	33						476.02	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	2	1	1	1	H6453_009_2	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	2	1	1	1	H6453_009_2	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	9	2	1	1	1	H6453_009_2	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	2	1	1	1	H6453_009_2	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	9	2	1	1	1	H6453_009_2	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	2	1	1	1	H6453_009_2	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	9	2	1	1	1	H6453_009_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											720.34	33						476.02	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	1	1	1	1	H6453_010_1	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	1	1	1	1	H6453_010_1	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	10	1	1	1	1	H6453_010_1	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	1	1	1	1	H6453_010_1	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	10	1	1	1	1	H6453_010_1	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	1	1	1	1	H6453_010_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	1	1	1	1	H6453_010_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											716.03	33						453.21	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	2	1	1	1	H6453_010_2	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	2	1	1	1	H6453_010_2	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					3	6	0					3	6	0																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	10	2	1	1	1	H6453_010_2	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	2	1	1	1	H6453_010_2	9	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					12	24	0					12	24	0																18				12			0.6	0.4	0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6453	10	2	1	1	1	H6453_010_2	9	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				45			1.57	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	2	1	1	1	H6453_010_2	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6453	10	2	1	1	1	H6453_010_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											716.03	33						453.21	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6502	1	0	1	4	1	H6502_001_0	16	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	0																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	1	0	1	4	1	H6502_001_0	16	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	12	24	0																					0																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	1	0	1	4	1	H6502_001_0	16	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	1	0	1	4	1	H6502_001_0	16	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	1	0	1	4	1	H6502_001_0	16	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				0	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	2	0	1	4	1	H6502_002_0	16	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	0																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	2	0	1	4	1	H6502_002_0	16	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	0																					0																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	2	0	1	4	1	H6502_002_0	16	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	2	0	1	4	1	H6502_002_0	16	Non-Preferred Brand	4	10	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6502	2	0	1	4	1	H6502_002_0	16	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				0	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6526	1	0	1	1	1	H6526_001_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	1	0	1	1	1	H6526_001_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	1	0	1	1	1	H6526_001_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	1	0	1	1	1	H6526_001_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	1	0	1	1	1	H6526_001_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				935	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	2	0	1	1	1	H6526_002_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	2	0	1	1	1	H6526_002_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	2	0	1	1	1	H6526_002_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	2	0	1	1	1	H6526_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6526	2	0	1	1	1	H6526_002_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				924	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6528	6	0	1	4	1	H6528_006_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		8																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6528	6	0	1	4	1	H6528_006_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6528	6	0	1	4	1	H6528_006_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6528	6	0	1	4	1	H6528_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6528	6	0	1	4	1	H6528_006_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				894	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6550	1	0	1	1	1	H6550_001_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	1	0	1	1	1	H6550_001_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					9	18	27					9	18	27																15				15			0.5	0.3	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	1	0	1	1	1	H6550_001_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	1	0	1	1	1	H6550_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	1	0	1	1	1	H6550_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	1	0	1	1	1	H6550_001_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	3	0	1	1	1	H6550_003_0	2	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	3	0	1	1	1	H6550_003_0	2	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					9	18	27					9	18	27																15				15			0.5	0.3	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	3	0	1	1	1	H6550_003_0	2	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	3	0	1	1	1	H6550_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	270																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	3	0	1	1	1	H6550_003_0	2	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	3	0	1	1	1	H6550_003_0	2	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	4	0	1	1	1	H6550_004_0	3	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	4	0	1	1	1	H6550_004_0	3	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	4	0	1	1	1	H6550_004_0	3	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	4	0	1	1	1	H6550_004_0	3	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	4	0	1	1	1	H6550_004_0	3	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6550	4	0	1	1	1	H6550_004_0	3	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6622	1	0	1	1	1	H6622_001_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	1	0	1	1	1	H6622_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	1	0	1	1	1	H6622_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	1	0	1	1	1	H6622_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	1	0	1	1	1	H6622_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	2	0	1	1	1	H6622_002_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	2	0	1	1	1	H6622_002_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	2	0	1	1	1	H6622_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	2	0	1	1	1	H6622_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	2	0	1	1	1	H6622_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	4	0	1	1	1	H6622_004_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	4	0	1	1	1	H6622_004_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	4	0	1	1	1	H6622_004_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	4	0	1	1	1	H6622_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	4	0	1	1	1	H6622_004_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	5	0	1	1	1	H6622_005_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	5	0	1	1	1	H6622_005_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	5	0	1	1	1	H6622_005_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	5	0	1	1	1	H6622_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	5	0	1	1	1	H6622_005_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	7	0	1	1	1	H6622_007_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	7	0	1	1	1	H6622_007_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	7	0	1	1	1	H6622_007_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	7	0	1	1	1	H6622_007_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											47	50		50				47	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	7	0	1	1	1	H6622_007_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	8	0	1	1	1	H6622_008_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	8	0	1	1	1	H6622_008_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	8	0	1	1	1	H6622_008_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	8	0	1	1	1	H6622_008_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	8	0	1	1	1	H6622_008_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	10	0	1	1	1	H6622_010_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	10	0	1	1	1	H6622_010_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	10	0	1	1	1	H6622_010_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	10	0	1	1	1	H6622_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	10	0	1	1	1	H6622_010_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	11	0	1	1	1	H6622_011_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	11	0	1	1	1	H6622_011_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	11	0	1	1	1	H6622_011_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	11	0	1	1	1	H6622_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	11	0	1	1	1	H6622_011_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	13	0	1	1	1	H6622_013_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	13	0	1	1	1	H6622_013_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	13	0	1	1	1	H6622_013_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	13	0	1	1	1	H6622_013_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	13	0	1	1	1	H6622_013_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	14	0	1	1	1	H6622_014_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	14	0	1	1	1	H6622_014_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	14	0	1	1	1	H6622_014_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	14	0	1	1	1	H6622_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	14	0	1	1	1	H6622_014_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	15	0	1	1	1	H6622_015_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	15	0	1	1	1	H6622_015_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	15	0	1	1	1	H6622_015_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	15	0	1	1	1	H6622_015_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	15	0	1	1	1	H6622_015_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	16	0	1	1	1	H6622_016_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	16	0	1	1	1	H6622_016_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	16	0	1	1	1	H6622_016_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	16	0	1	1	1	H6622_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	16	0	1	1	1	H6622_016_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	17	0	1	1	1	H6622_017_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6622	17	0	1	1	1	H6622_017_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6622	17	0	1	1	1	H6622_017_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6622	17	0	1	1	1	H6622_017_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6622	17	0	1	1	1	H6622_017_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	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	17	0	1	1	1	H6622_017_0	3	Select Care Drugs	4	11	1	2	6	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					7		21											11		33				7		0				11				11			0.37	0.23		0.37	0.23	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6622	18	0	1	1	1	H6622_018_0	7	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	18	0	1	1	1	H6622_018_0	7	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	18	0	1	1	1	H6622_018_0	7	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	18	0	1	1	1	H6622_018_0	7	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	18	0	1	1	1	H6622_018_0	7	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	19	0	1	1	1	H6622_019_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	19	0	1	1	1	H6622_019_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	19	0	1	1	1	H6622_019_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	19	0	1	1	1	H6622_019_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	19	0	1	1	1	H6622_019_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	1	1	1	1	H6622_021_1	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	1	1	1	1	H6622_021_1	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	1	1	1	1	H6622_021_1	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	1	1	1	1	H6622_021_1	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	1	1	1	1	H6622_021_1	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	2	1	1	1	H6622_021_2	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	2	1	1	1	H6622_021_2	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	2	1	1	1	H6622_021_2	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	2	1	1	1	H6622_021_2	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	21	2	1	1	1	H6622_021_2	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	22	0	1	1	1	H6622_022_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	22	0	1	1	1	H6622_022_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	22	0	1	1	1	H6622_022_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	22	0	1	1	1	H6622_022_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	22	0	1	1	1	H6622_022_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	23	0	1	1	1	H6622_023_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	23	0	1	1	1	H6622_023_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	23	0	1	1	1	H6622_023_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	23	0	1	1	1	H6622_023_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	23	0	1	1	1	H6622_023_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	25	0	1	1	1	H6622_025_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	25	0	1	1	1	H6622_025_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	25	0	1	1	1	H6622_025_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	25	0	1	1	1	H6622_025_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	25	0	1	1	1	H6622_025_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	26	0	1	1	1	H6622_026_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	26	0	1	1	1	H6622_026_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	26	0	1	1	1	H6622_026_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	26	0	1	1	1	H6622_026_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	26	0	1	1	1	H6622_026_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	27	0	1	1	1	H6622_027_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	27	0	1	1	1	H6622_027_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	27	0	1	1	1	H6622_027_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	27	0	1	1	1	H6622_027_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	27	0	1	1	1	H6622_027_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	28	0	1	1	1	H6622_028_0	5	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	28	0	1	1	1	H6622_028_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	28	0	1	1	1	H6622_028_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	28	0	1	1	1	H6622_028_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	28	0	1	1	1	H6622_028_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	29	0	1	1	1	H6622_029_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	29	0	1	1	1	H6622_029_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	3
H6622	29	0	1	1	1	H6622_029_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	29	0	1	1	1	H6622_029_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	29	0	1	1	1	H6622_029_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	29	0	1	1	1	H6622_029_0	4	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	29	0	1	1	1	H6622_029_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	29	0	1	1	1	H6622_029_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	29	0	1	1	1	H6622_029_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	29	0	1	1	1	H6622_029_0	4	Specialty Tier	4	11	1	1	5	3		10	1		10	1				30								30			30		31												15							15												15						15					15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	30	0	1	1	1	H6622_030_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	30	0	1	1	1	H6622_030_0	4	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	3
H6622	30	0	1	1	1	H6622_030_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					2		6											20		60				2		0				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	30	0	1	1	1	H6622_030_0	4	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					2		6											20		60				2		0				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	30	0	1	1	1	H6622_030_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	30	0	1	1	1	H6622_030_0	4	Preferred Brand	4	11	1	2	3	3		110	1		110	1				30		90	2	2				30		90	30		31								47		141					40		120											47		141				40		110				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	30	0	1	1	1	H6622_030_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	30	0	1	1	1	H6622_030_0	4	Non-Preferred Drug	4	11	1	2	4	3		110	1		110	1				30		90	2	2				30		90	30		31								100		300					80		240											100		300				80		230				100				100			3.33	2.67		3.33	2.67	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	30	0	1	1	1	H6622_030_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	30	0	1	1	1	H6622_030_0	4	Specialty Tier	4	11	1	1	5	3		10	1		10	1				30								30			30		31												15							15												15						15					15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	3	
H6622	31	0	1	1	1	H6622_031_0	9	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	31	0	1	1	1	H6622_031_0	9	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	31	0	1	1	1	H6622_031_0	9	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	31	0	1	1	1	H6622_031_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	31	0	1	1	1	H6622_031_0	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	32	0	1	1	1	H6622_032_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	32	0	1	1	1	H6622_032_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	32	0	1	1	1	H6622_032_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	32	0	1	1	1	H6622_032_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	32	0	1	1	1	H6622_032_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	33	0	1	1	1	H6622_033_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	33	0	1	1	1	H6622_033_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	33	0	1	1	1	H6622_033_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	33	0	1	1	1	H6622_033_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	33	0	1	1	1	H6622_033_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	34	0	1	1	1	H6622_034_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	34	0	1	1	1	H6622_034_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	34	0	1	1	1	H6622_034_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	34	0	1	1	1	H6622_034_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	34	0	1	1	1	H6622_034_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	35	0	1	1	1	H6622_035_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	35	0	1	1	1	H6622_035_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	35	0	1	1	1	H6622_035_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	35	0	1	1	1	H6622_035_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	35	0	1	1	1	H6622_035_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	36	0	1	1	1	H6622_036_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	36	0	1	1	1	H6622_036_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	36	0	1	1	1	H6622_036_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	36	0	1	1	1	H6622_036_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	36	0	1	1	1	H6622_036_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	37	0	1	1	1	H6622_037_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	37	0	1	1	1	H6622_037_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	37	0	1	1	1	H6622_037_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	37	0	1	1	1	H6622_037_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	37	0	1	1	1	H6622_037_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	38	0	1	1	1	H6622_038_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	38	0	1	1	1	H6622_038_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	38	0	1	1	1	H6622_038_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	38	0	1	1	1	H6622_038_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	38	0	1	1	1	H6622_038_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	40	0	1	1	1	H6622_040_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	40	0	1	1	1	H6622_040_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	40	0	1	1	1	H6622_040_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	40	0	1	1	1	H6622_040_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	40	0	1	1	1	H6622_040_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	41	0	1	1	1	H6622_041_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	41	0	1	1	1	H6622_041_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	41	0	1	1	1	H6622_041_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	41	0	1	1	1	H6622_041_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	41	0	1	1	1	H6622_041_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	47	0	1	1	1	H6622_047_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	47	0	1	1	1	H6622_047_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	47	0	1	1	1	H6622_047_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	47	0	1	1	1	H6622_047_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					90		270											100		300				90		260				100				100			3.33	3		3.33	3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	47	0	1	1	1	H6622_047_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	48	0	1	1	1	H6622_048_0	6	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	48	0	1	1	1	H6622_048_0	6	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	48	0	1	1	1	H6622_048_0	6	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	48	0	1	1	1	H6622_048_0	6	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	48	0	1	1	1	H6622_048_0	6	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	49	0	1	1	1	H6622_049_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	49	0	1	1	1	H6622_049_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	49	0	1	1	1	H6622_049_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	49	0	1	1	1	H6622_049_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	49	0	1	1	1	H6622_049_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	1	1	1	1	H6622_050_1	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	1	1	1	1	H6622_050_1	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	1	1	1	1	H6622_050_1	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	1	1	1	1	H6622_050_1	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	1	1	1	1	H6622_050_1	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	2	1	1	1	H6622_050_2	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	2	1	1	1	H6622_050_2	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	2	1	1	1	H6622_050_2	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	2	1	1	1	H6622_050_2	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	50	2	1	1	1	H6622_050_2	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	51	0	1	1	1	H6622_051_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	51	0	1	1	1	H6622_051_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					7		21											20		60				7		0				20				20			0.67	0.23		0.67	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	51	0	1	1	1	H6622_051_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	51	0	1	1	1	H6622_051_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	51	0	1	1	1	H6622_051_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	52	0	1	1	1	H6622_052_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	52	0	1	1	1	H6622_052_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	52	0	1	1	1	H6622_052_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	52	0	1	1	1	H6622_052_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	52	0	1	1	1	H6622_052_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	54	0	1	1	1	H6622_054_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	54	0	1	1	1	H6622_054_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	54	0	1	1	1	H6622_054_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	54	0	1	1	1	H6622_054_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	54	0	1	1	1	H6622_054_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	55	0	1	1	1	H6622_055_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	55	0	1	1	1	H6622_055_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	55	0	1	1	1	H6622_055_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	55	0	1	1	1	H6622_055_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	55	0	1	1	1	H6622_055_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	56	0	1	1	1	H6622_056_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	56	0	1	1	1	H6622_056_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					0		0											20		60				0		0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	56	0	1	1	1	H6622_056_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	56	0	1	1	1	H6622_056_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	56	0	1	1	1	H6622_056_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	57	0	1	1	1	H6622_057_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	57	0	1	1	1	H6622_057_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	57	0	1	1	1	H6622_057_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	57	0	1	1	1	H6622_057_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	57	0	1	1	1	H6622_057_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	58	0	1	1	1	H6622_058_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	58	0	1	1	1	H6622_058_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	58	0	1	1	1	H6622_058_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	58	0	1	1	1	H6622_058_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	58	0	1	1	1	H6622_058_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	59	0	1	1	1	H6622_059_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	59	0	1	1	1	H6622_059_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	59	0	1	1	1	H6622_059_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	59	0	1	1	1	H6622_059_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	59	0	1	1	1	H6622_059_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	60	0	1	1	1	H6622_060_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	60	0	1	1	1	H6622_060_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	60	0	1	1	1	H6622_060_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	60	0	1	1	1	H6622_060_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	60	0	1	1	1	H6622_060_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	61	0	1	1	1	H6622_061_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	61	0	1	1	1	H6622_061_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	61	0	1	1	1	H6622_061_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	61	0	1	1	1	H6622_061_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	61	0	1	1	1	H6622_061_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	62	0	1	2	1	H6622_062_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	62	0	1	2	1	H6622_062_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					6		18											20		60				6		0				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	62	0	1	2	1	H6622_062_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	62	0	1	2	1	H6622_062_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											54	50		50				54	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	62	0	1	2	1	H6622_062_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	63	0	1	1	1	H6622_063_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	63	0	1	1	1	H6622_063_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	63	0	1	1	1	H6622_063_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	63	0	1	1	1	H6622_063_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	63	0	1	1	1	H6622_063_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	64	0	1	1	1	H6622_064_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	64	0	1	1	1	H6622_064_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	64	0	1	1	1	H6622_064_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	64	0	1	1	1	H6622_064_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	64	0	1	1	1	H6622_064_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	66	0	1	1	1	H6622_066_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	66	0	1	1	1	H6622_066_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	66	0	1	1	1	H6622_066_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	66	0	1	1	1	H6622_066_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	66	0	1	1	1	H6622_066_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	69	0	1	1	1	H6622_069_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	69	0	1	1	1	H6622_069_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	69	0	1	1	1	H6622_069_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	69	0	1	1	1	H6622_069_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	69	0	1	1	1	H6622_069_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	70	0	1	1	1	H6622_070_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	70	0	1	1	1	H6622_070_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	70	0	1	1	1	H6622_070_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	70	0	1	1	1	H6622_070_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6622	70	0	1	1	1	H6622_070_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	1	0	1	1	1	H6672_001_0	6	Preferred Generic	4	1	1	1	1	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	1	0	1	1	1	H6672_001_0	6	Generic	4	1	3	1	2	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	1	0	1	1	1	H6672_001_0	6	Preferred Brand	4	10	1	1	3	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	1	0	1	1	1	H6672_001_0	6	Non-Preferred Drug	4	10	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	1	0	1	1	1	H6672_001_0	6	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	3	0	1	1	1	H6672_003_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6672	3	0	1	1	1	H6672_003_0	6	Generic	4	1	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	15		45																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6672	3	0	1	1	1	H6672_003_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6672	3	0	1	1	1	H6672_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6672	3	0	1	1	1	H6672_003_0	6	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				654.27	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6672	3	0	1	1	1	H6672_003_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	9		27																			9		18																9				9		0.3			0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6672	4	0	1	1	1	H6672_004_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	4	0	1	1	1	H6672_004_0	7	Generic	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	4	0	1	1	1	H6672_004_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	4	0	1	1	1	H6672_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	95		285																			95		190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6672	4	0	1	1	1	H6672_004_0	7	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				575.1	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	1	1	1	1	H6723_001_1	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	1	1	1	1	H6723_001_1	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	1	1	1	1	1	H6723_001_1	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	1	1	1	1	H6723_001_1	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	1	1	1	1	1	H6723_001_1	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	1	1	1	1	H6723_001_1	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											46.8	50		50				44.22	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	1	1	1	1	H6723_001_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	2	1	1	1	H6723_001_2	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	2	1	1	1	H6723_001_2	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	1	2	1	1	1	H6723_001_2	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	2	1	1	1	H6723_001_2	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	1	2	1	1	1	H6723_001_2	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	2	1	1	1	H6723_001_2	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											46.8	50		50				44.22	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	1	2	1	1	1	H6723_001_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	1	1	1	1	H6723_002_1	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	1	1	1	1	H6723_002_1	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	2	1	1	1	1	H6723_002_1	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	1	1	1	1	H6723_002_1	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	2	1	1	1	1	H6723_002_1	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	1	1	1	1	H6723_002_1	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											31.99	50		50				42.41	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	1	1	1	1	H6723_002_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	2	1	1	1	H6723_002_2	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	2	1	1	1	H6723_002_2	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	2	2	1	1	1	H6723_002_2	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	2	1	1	1	H6723_002_2	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	2	2	1	1	1	H6723_002_2	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	2	1	1	1	H6723_002_2	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											31.99	50		50				42.41	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	2	2	1	1	1	H6723_002_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	1	1	1	1	H6723_003_1	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	1	1	1	1	H6723_003_1	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	3	1	1	1	1	H6723_003_1	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	1	1	1	1	H6723_003_1	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	3	1	1	1	1	H6723_003_1	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	1	1	1	1	H6723_003_1	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											43.34	50		50				38.7	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	1	1	1	1	H6723_003_1	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	2	1	1	1	H6723_003_2	11	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	2	1	1	1	H6723_003_2	11	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								6		12					0		0					0		0																6				6			0.2	0	0			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	3	2	1	1	1	H6723_003_2	11	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	2	1	1	1	H6723_003_2	11	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								15		38					10		25					9		22																15				15			0.5	0.33	0.3			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	3	2	1	1	1	H6723_003_2	11	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	2	1	1	1	H6723_003_2	11	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											43.34	50		50				38.7	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	3	2	1	1	1	H6723_003_2	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												32							32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	4	0	1	1	1	H6723_004_0	12	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	4	0	1	1	1	H6723_004_0	12	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	4	0	1	1	1	H6723_004_0	12	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	4	0	1	1	1	H6723_004_0	12	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								20		50					15		38					14		35																20				20			0.67	0.5	0.47			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6723	4	0	1	1	1	H6723_004_0	12	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		132					42		118					40		110																47				47			1.57	1.4	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	4	0	1	1	1	H6723_004_0	12	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											51.98	50		50				64.36	50		50				50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6723	4	0	1	1	1	H6723_004_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6743	1	0	1	4	1	H6743_001_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	1	0	1	4	1	H6743_001_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	20		40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	1	0	1	4	1	H6743_001_0	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		90																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	1	0	1	4	1	H6743_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		190																					190																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	1	0	1	4	1	H6743_001_0	7	Specialty Tier	4	10	1	1	5	1	10		1			1	30														30		31				1054.19	29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	1	0	1	4	1	H6743_001_0	7	Select Care Drugs	4	10	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	7	0	1	4	1	H6743_007_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	7	0	1	4	1	H6743_007_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	20		40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	7	0	1	4	1	H6743_007_0	7	Preferred Brand	4	11	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		90																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	7	0	1	4	1	H6743_007_0	7	Non-Preferred Drug	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		190																					190																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	7	0	1	4	1	H6743_007_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1139.48	30																																					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	7	0	1	4	1	H6743_007_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	1	1	4	1	H6743_018_1	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	1	1	4	1	H6743_018_1	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	20		40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	1	1	4	1	H6743_018_1	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		90																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	1	1	4	1	H6743_018_1	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		190																					190																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	1	1	4	1	H6743_018_1	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1270.96	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	1	1	4	1	H6743_018_1	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	3	1	4	1	H6743_018_3	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	3	1	4	1	H6743_018_3	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	20		40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	3	1	4	1	H6743_018_3	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		90																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	3	1	4	1	H6743_018_3	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		190																					190																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	3	1	4	1	H6743_018_3	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1270.96	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	18	3	1	4	1	H6743_018_3	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	1	1	4	1	H6743_020_1	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	6		12																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	1	1	4	1	H6743_020_1	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		30																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	1	1	4	1	H6743_020_1	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		80																					80																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	1	1	4	1	H6743_020_1	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	85		170																					170																85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	1	1	4	1	H6743_020_1	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				810.48	29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	1	1	4	1	H6743_020_1	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	2	1	4	1	H6743_020_2	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	6		12																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	2	1	4	1	H6743_020_2	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		30																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	2	1	4	1	H6743_020_2	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		80																					80																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	2	1	4	1	H6743_020_2	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	85		170																					170																85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	2	1	4	1	H6743_020_2	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				810.48	29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	2	1	4	1	H6743_020_2	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	3	1	4	1	H6743_020_3	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	6		12																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	3	1	4	1	H6743_020_3	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		30																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	3	1	4	1	H6743_020_3	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		80																					80																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	3	1	4	1	H6743_020_3	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	85		170																					170																85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	3	1	4	1	H6743_020_3	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				810.48	29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	3	1	4	1	H6743_020_3	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	4	1	4	1	H6743_020_4	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	6		12																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	4	1	4	1	H6743_020_4	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		30																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	4	1	4	1	H6743_020_4	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		80																					80																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	4	1	4	1	H6743_020_4	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	85		170																					170																85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	4	1	4	1	H6743_020_4	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				810.48	29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	20	4	1	4	1	H6743_020_4	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	2	1	4	1	H6743_021_2	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	4		8																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	2	1	4	1	H6743_021_2	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	2	1	4	1	H6743_021_2	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	35		70																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	2	1	4	1	H6743_021_2	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	75		150																					150																75				75		2.5						2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	2	1	4	1	H6743_021_2	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				798.23	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	2	1	4	1	H6743_021_2	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	4	1	4	1	H6743_021_4	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	4		8																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	4	1	4	1	H6743_021_4	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	4	1	4	1	H6743_021_4	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	35		70																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	4	1	4	1	H6743_021_4	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	75		150																					150																75				75		2.5						2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	4	1	4	1	H6743_021_4	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				798.23	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6743	21	4	1	4	1	H6743_021_4	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6750	5	0	1	1	1	H6750_005_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	5	0	1	1	1	H6750_005_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	5	0	1	1	1	H6750_005_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	5	0	1	1	1	H6750_005_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	5	0	1	1	1	H6750_005_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	5	0	1	1	1	H6750_005_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1495	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	6	0	1	1	1	H6750_006_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	6	0	1	1	1	H6750_006_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	6	0	1	1	1	H6750_006_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	6	0	1	1	1	H6750_006_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	6	0	1	1	1	H6750_006_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	6	0	1	1	1	H6750_006_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1495	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	7	0	1	1	1	H6750_007_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	7	0	1	1	1	H6750_007_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	7	0	1	1	1	H6750_007_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	7	0	1	1	1	H6750_007_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	7	0	1	1	1	H6750_007_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	7	0	1	1	1	H6750_007_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1555	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	8	0	1	1	1	H6750_008_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	8	0	1	1	1	H6750_008_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	8	0	1	1	1	H6750_008_0	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	8	0	1	1	1	H6750_008_0	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	8	0	1	1	1	H6750_008_0	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	8	0	1	1	1	H6750_008_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1975	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	9	0	1	1	1	H6750_009_0	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	9	0	1	1	1	H6750_009_0	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	9	0	1	1	1	H6750_009_0	4	Generic	4	1	3	1	2	1	111		1	100		1	30	60	90				1	2			90				30		31				8.38	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	9	0	1	1	1	H6750_009_0	4	Preferred Brand	4	11	1	1	3	1	111		1	100		1	30	60	90				1	2			90				30		31				120	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	9	0	1	1	1	H6750_009_0	4	Non-Preferred Brand	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				138	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	9	0	1	1	1	H6750_009_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1495	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	1	1	1	1	H6750_010_1	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	1	1	1	1	H6750_010_1	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	10	1	1	1	1	H6750_010_1	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	1	1	1	1	H6750_010_1	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	1	1	1	1	H6750_010_1	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	1	1	1	1	H6750_010_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1675	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	2	1	1	1	H6750_010_2	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	2	1	1	1	H6750_010_2	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	10	2	1	1	1	H6750_010_2	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	2	1	1	1	H6750_010_2	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	2	1	1	1	H6750_010_2	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	10	2	1	1	1	H6750_010_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1675	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	1	1	2	1	H6750_011_1	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	1	1	2	1	H6750_011_1	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	11	1	1	2	1	H6750_011_1	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	1	1	2	1	H6750_011_1	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	1	1	2	1	H6750_011_1	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	1	1	2	1	H6750_011_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1675	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	2	1	2	1	H6750_011_2	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	2	1	2	1	H6750_011_2	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	11	2	1	2	1	H6750_011_2	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	2	1	2	1	H6750_011_2	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	2	1	2	1	H6750_011_2	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	11	2	1	2	1	H6750_011_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1675	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	1	1	1	1	H6750_012_1	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	1	1	1	1	H6750_012_1	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	12	1	1	1	1	H6750_012_1	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	1	1	1	1	H6750_012_1	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	1	1	1	1	H6750_012_1	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	1	1	1	1	H6750_012_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1675	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	2	1	1	1	H6750_012_2	4	Preferred Generic	4	1	3	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	2	1	1	1	H6750_012_2	4	Preferred Generic	4	1	3	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		3
H6750	12	2	1	1	1	H6750_012_2	4	Generic	4	1	3	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	2	1	1	1	H6750_012_2	4	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	2	1	1	1	H6750_012_2	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6750	12	2	1	1	1	H6750_012_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1675	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6786	2	0	1	4	1	H6786_002_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6786	2	0	1	4	1	H6786_002_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6786	2	0	1	4	1	H6786_002_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6786	2	0	1	4	1	H6786_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6786	2	0	1	4	1	H6786_002_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6786	2	0	1	4	1	H6786_002_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6786	2	0	1	4	1	H6786_002_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H6815	3	1	1	1	1	H6815_003_1	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	1	1	1	1	H6815_003_1	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					8	16	24					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	1	1	1	1	H6815_003_1	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	1	1	1	1	H6815_003_1	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	1	1	1	1	H6815_003_1	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	1	1	1	1	H6815_003_1	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	2	1	1	1	H6815_003_2	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	2	1	1	1	H6815_003_2	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					8	16	24					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	2	1	1	1	H6815_003_2	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	2	1	1	1	H6815_003_2	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	2	1	1	1	H6815_003_2	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	2	1	1	1	H6815_003_2	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	3	1	1	1	H6815_003_3	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	3	1	1	1	H6815_003_3	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					8	16	24					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	3	1	1	1	H6815_003_3	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	3	1	1	1	H6815_003_3	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	3	1	1	1	H6815_003_3	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	3	3	1	1	1	H6815_003_3	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	5	0	1	1	1	H6815_005_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	5	0	1	1	1	H6815_005_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					8	16	24					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	5	0	1	1	1	H6815_005_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	5	0	1	1	1	H6815_005_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	5	0	1	1	1	H6815_005_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	5	0	1	1	1	H6815_005_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	6	0	1	1	1	H6815_006_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	6	0	1	1	1	H6815_006_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					8	16	24					8	16	16																15				15			0.5	0.27	0.27			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	6	0	1	1	1	H6815_006_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	6	0	1	1	1	H6815_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	225																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	6	0	1	1	1	H6815_006_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6815	6	0	1	1	1	H6815_006_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H6821	1	0	1	1	1	H6821_001_0	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					0	0	0					7	14	0																7				7			0.23	0	0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	1	0	1	1	1	H6821_001_0	5	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					0	0	0					14	28	0																14				14			0.47	0	0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	1	0	1	1	1	H6821_001_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	115																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	1	0	1	1	1	H6821_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								97	194	291					87	174	261					97	194	275																97				97			3.23	2.9	3.23			3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	1	0	1	1	1	H6821_001_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											649.65	33						649.65	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	2	0	1	1	1	H6821_002_0	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	2	0	1	1	1	H6821_002_0	5	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	0																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	2	0	1	1	1	H6821_002_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	115																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	2	0	1	1	1	H6821_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								97	194	291					85	170	255					85	170	240																97				97			3.23	2.83	2.83			3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	2	0	1	1	1	H6821_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											649.65	33						649.65	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	3	0	1	1	1	H6821_003_0	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					2	4	6					8	16	0																8				8			0.27	0.07	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	3	0	1	1	1	H6821_003_0	5	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					7	14	21					15	30	0																15				15			0.5	0.23	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	3	0	1	1	1	H6821_003_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	115																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	3	0	1	1	1	H6821_003_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								97	194	291					85	170	255					97	194	240																97				97			3.23	2.83	3.23			3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	3	0	1	1	1	H6821_003_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											598.33	33						598.33	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	4	0	1	1	1	H6821_004_0	5	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	24					2	4	6					8	16	0																8				8			0.27	0.07	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	4	0	1	1	1	H6821_004_0	5	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					7	14	21					15	30	0																15				15			0.5	0.23	0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	4	0	1	1	1	H6821_004_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					47	94	115																47				47			1.57	1.4	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	4	0	1	1	1	H6821_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								97	194	291					85	170	255					97	194	240																97				97			3.23	2.83	3.23			3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6821	4	0	1	1	1	H6821_004_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											598.33	33						598.33	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6832	2	0	1	1	1	H6832_002_0	6	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2	4	6																																						2			2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6832	2	0	1	1	1	H6832_002_0	6	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6832	2	0	1	1	1	H6832_002_0	6	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6832	2	0	1	1	1	H6832_002_0	6	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6832	2	0	1	1	1	H6832_002_0	6	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31				760.21	25																																						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6870	1	0	1	48	5	H6870_001_0	4	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H6870	1	0	1	48	5	H6870_001_0	4	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H6870	1	0	1	48	5	H6870_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H6910	1	0	1	1	1	H6910_001_0	9	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	1	0	1	1	1	H6910_001_0	9	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6910	1	0	1	1	1	H6910_001_0	9	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31								20	40	60					6	12	18					0	0	0																20				20			0.67	0.2	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	1	0	1	1	1	H6910_001_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					31	62	93					31	62	62																47				47			1.57	1.03	1.03			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	1	0	1	1	1	H6910_001_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	180																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	1	0	1	1	1	H6910_001_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											670	33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	2	0	1	1	1	H6910_002_0	9	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	2	0	1	1	1	H6910_002_0	9	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6910	2	0	1	1	1	H6910_002_0	9	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31								20	40	60					6	12	18					0	0	0																20				20			0.67	0.2	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	2	0	1	1	1	H6910_002_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					31	62	93					31	62	62																47				47			1.57	1.03	1.03			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	2	0	1	1	1	H6910_002_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	180																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	2	0	1	1	1	H6910_002_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											670	33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	3	0	1	1	1	H6910_003_0	9	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	3	0	1	1	1	H6910_003_0	9	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H6910	3	0	1	1	1	H6910_003_0	9	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31								20	40	60					6	12	18					0	0	0																20				20			0.67	0.2	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	3	0	1	1	1	H6910_003_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					31	62	93					31	62	62																47				47			1.57	1.03	1.03			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	3	0	1	1	1	H6910_003_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	180																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6910	3	0	1	1	1	H6910_003_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											670	33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6936	3	0	1	1	1	H6936_003_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		2																					2																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	3	0	1	1	1	H6936_003_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	7		7																					7																7				7		0.23						0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	3	0	1	1	1	H6936_003_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	3	0	1	1	1	H6936_003_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	3	0	1	1	1	H6936_003_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	4	0	1	1	1	H6936_004_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		2																					2																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	4	0	1	1	1	H6936_004_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	7		7																					7																7				7		0.23						0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	4	0	1	1	1	H6936_004_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					120																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	4	0	1	1	1	H6936_004_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					270																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	4	0	1	1	1	H6936_004_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	5	0	1	1	1	H6936_005_0	9	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	2		2																					2																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	5	0	1	1	1	H6936_005_0	9	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	7		7																					7																7				7		0.23						0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	5	0	1	1	1	H6936_005_0	9	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	5	0	1	1	1	H6936_005_0	9	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6936	5	0	1	1	1	H6936_005_0	9	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6975	1	0	1	1	1	H6975_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6975	1	0	1	1	1	H6975_001_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6975	1	0	1	1	1	H6975_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6975	1	0	1	1	1	H6975_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	99		297																									99		297				99		198				99				99		3.3				3.3	3.3	3.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6975	1	0	1	1	1	H6975_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					28																										28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H6988	1	0	1	1	1	H6988_001_0	13	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	3		9																					0																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6988	1	0	1	1	1	H6988_001_0	13	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	15		45																					37.5																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6988	1	0	1	1	1	H6988_001_0	13	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	47		141																					117.5																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6988	1	0	1	1	1	H6988_001_0	13	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	100		300																					250																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H6988	1	0	1	1	1	H6988_001_0	13	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7006	1	0	1	4	1	H7006_001_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	4		8																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	1	0	1	4	1	H7006_001_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	1	0	1	4	1	H7006_001_0	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	35		70																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	1	0	1	4	1	H7006_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	75		150																					150																75				75		2.5						2.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	1	0	1	4	1	H7006_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				672.96	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	1	0	1	4	1	H7006_001_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	3	0	1	4	1	H7006_003_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	6		12																					12																6				6		0.2						0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	3	0	1	4	1	H7006_003_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		30																					30																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	3	0	1	4	1	H7006_003_0	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		80																					80																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	3	0	1	4	1	H7006_003_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	85		170																					170																85				85		2.83						2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	3	0	1	4	1	H7006_003_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				757.65	29																																					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7006	3	0	1	4	1	H7006_003_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7020	4	0	1	1	1	H7020_004_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	4	0	1	1	1	H7020_004_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	45					10	20	20											15	30	45				10	20	0				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	4	0	1	1	1	H7020_004_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	4	0	1	1	1	H7020_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	4	0	1	1	1	H7020_004_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1123.05	33						929.67	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	6	0	1	1	1	H7020_006_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	6	0	1	1	1	H7020_006_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	6	0	1	1	1	H7020_006_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								40	80	120					35	70	105											40	80	120				35	70	105				40				40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	6	0	1	1	1	H7020_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	6	0	1	1	1	H7020_006_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1120.49	33						947.25	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	7	0	1	1	1	H7020_007_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	4											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	7	0	1	1	1	H7020_007_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	45					10	20	20											15	30	45				10	20	0				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	7	0	1	1	1	H7020_007_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	7	0	1	1	1	H7020_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7020	7	0	1	1	1	H7020_007_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1120.49	33						947.25	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	1	0	1	4	1	H7063_001_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	1	0	1	4	1	H7063_001_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	1	0	1	4	1	H7063_001_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	21	28					7	14	21					7	14	21																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	1	0	1	4	1	H7063_001_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	21	28					7	14	21					7	14	21																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	1	0	1	4	1	H7063_001_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	1	0	1	4	1	H7063_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	1	0	1	4	1	H7063_001_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	2	0	1	4	1	H7063_002_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	13	16					3	6	9					3	6	9																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	2	0	1	4	1	H7063_002_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	13	16					3	6	9					3	6	9																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	2	0	1	4	1	H7063_002_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	2	0	1	4	1	H7063_002_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	2	0	1	4	1	H7063_002_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					45	90	135					45	90	135																45				45			1.5	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	2	0	1	4	1	H7063_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	2	0	1	4	1	H7063_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	6	0	1	4	1	H7063_006_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	6	0	1	4	1	H7063_006_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	6	0	1	4	1	H7063_006_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	21	28					7	14	21					7	14	21																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	6	0	1	4	1	H7063_006_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	21	28					7	14	21					7	14	21																14				14			0.47	0.23	0.23			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	6	0	1	4	1	H7063_006_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	6	0	1	4	1	H7063_006_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	6	0	1	4	1	H7063_006_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	7	0	1	4	1	H7063_007_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	13	16					3	6	9					3	6	9																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	7	0	1	4	1	H7063_007_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	13	16					3	6	9					3	6	9																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	7	0	1	4	1	H7063_007_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	7	0	1	4	1	H7063_007_0	8	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	17	22					5	10	15					5	10	15																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7063	7	0	1	4	1	H7063_007_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					45	90	135					45	90	135																45				45			1.5	1.5	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	7	0	1	4	1	H7063_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7063	7	0	1	4	1	H7063_007_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7115	1	0	1	1	1	H7115_001_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					2	4	4					2	0	0																10				10			0.33	0.07	0.07			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7115	1	0	1	1	1	H7115_001_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	36					10	20	20					10	20	20																18				18			0.6	0.33	0.33			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7115	1	0	1	1	1	H7115_001_0	7	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	94					39	78	78					39	78	78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7115	1	0	1	1	1	H7115_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	200					92	184	184					92	184	184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7115	1	0	1	1	1	H7115_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7123	1	0	1	1	1	H7123_001_0	9	Preferred Generic	2	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								9		27					2		4							4																9				9			0.3	0.07				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7123	1	0	1	1	1	H7123_001_0	9	Generic	2	11	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								15		45					8		16							16																15				15			0.5	0.27				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7123	1	0	1	1	1	H7123_001_0	9	Preferred Brand	2	11	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								17		51					10		25							25																17				17			0.57	0.33				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7123	1	0	1	1	1	H7123_001_0	9	Non-Preferred Drug	2	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											57.57	46		46				62.56	46		46						46															46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7123	1	0	1	1	1	H7123_001_0	9	Specialty Tier	2	11	1	1	5	1		10	1	10		1				30					30						30		31											397.13	25						479.74	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7149	1	0	1	1	1	H7149_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	1	0	1	1	1	H7149_001_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7149	1	0	1	1	1	H7149_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	1	0	1	1	1	H7149_001_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7149	1	0	1	1	1	H7149_001_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	1	0	1	1	1	H7149_001_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	1	0	1	1	1	H7149_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											922.98	33						855.04	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	4	0	1	1	1	H7149_004_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	4	0	1	1	1	H7149_004_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7149	4	0	1	1	1	H7149_004_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	4	0	1	1	1	H7149_004_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7149	4	0	1	1	1	H7149_004_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	4	0	1	1	1	H7149_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	4	0	1	1	1	H7149_004_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											788.68	33						774.24	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	6	0	1	1	1	H7149_006_0	4	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	6	0	1	1	1	H7149_006_0	4	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	6	0	1	1	1	H7149_006_0	4	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	6	0	1	1	1	H7149_006_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7149	6	0	1	1	1	H7149_006_0	4	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				608.9	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7165	1	0	1	1	1	H7165_001_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	1	0	1	1	1	H7165_001_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7165	1	0	1	1	1	H7165_001_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	45																			15	30	37.5																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	1	0	1	1	1	H7165_001_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	37	74	111																			37	74	92.5																37				37		1.23			1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	1	0	1	1	1	H7165_001_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				58.19	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	1	0	1	1	1	H7165_001_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	2	0	1	1	1	H7165_002_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	2	0	1	1	1	H7165_002_0	7	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7165	2	0	1	1	1	H7165_002_0	7	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	45																			15	30	37.5																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	2	0	1	1	1	H7165_002_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	37	74	111																			37	74	92.5																37				37		1.23			1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	2	0	1	1	1	H7165_002_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				61.79	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7165	2	0	1	1	1	H7165_002_0	7	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7172	1	0	1	48	5	H7172_001_0	4	Generic Drugs	4	11			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	0	0	0	0	0	0	0			
H7172	1	0	1	48	5	H7172_001_0	4	Brand Drugs	4	11			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	0	0	0	0	0	0	0			
H7172	1	0	1	48	5	H7172_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0			0	0			
H7173	1	0	1	1	1	H7173_001_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	1	0	1	1	1	H7173_001_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	21																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	1	0	1	1	1	H7173_001_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	1	0	1	1	1	H7173_001_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	1	0	1	1	1	H7173_001_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	1	0	1	1	1	H7173_001_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	2	0	1	1	1	H7173_002_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	2	0	1	1	1	H7173_002_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	21																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	2	0	1	1	1	H7173_002_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	2	0	1	1	1	H7173_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	2	0	1	1	1	H7173_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	2	0	1	1	1	H7173_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	7	0	1	1	1	H7173_007_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					5	10	15					5	10	15																10				10			0.33	0.17	0.17			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	7	0	1	1	1	H7173_007_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	45																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	7	0	1	1	1	H7173_007_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	7	0	1	1	1	H7173_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								96	192	288					86	172	258					86	172	258																96				96			3.2	2.87	2.87			3.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	7	0	1	1	1	H7173_007_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	7	0	1	1	1	H7173_007_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	8	0	1	1	1	H7173_008_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	8	0	1	1	1	H7173_008_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	21																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	8	0	1	1	1	H7173_008_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	8	0	1	1	1	H7173_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	8	0	1	1	1	H7173_008_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7173	8	0	1	1	1	H7173_008_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7175	1	0	1	4	1	H7175_001_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	1	0	1	4	1	H7175_001_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	1	0	1	4	1	H7175_001_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	1	0	1	4	1	H7175_001_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				97.62	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	1	0	1	4	1	H7175_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	2	0	1	4	1	H7175_002_0	8	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	2	0	1	4	1	H7175_002_0	8	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	2	0	1	4	1	H7175_002_0	8	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	2	0	1	4	1	H7175_002_0	8	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				99.49	47		47																								47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7175	2	0	1	4	1	H7175_002_0	8	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7220	4	0	1	2	1	H7220_004_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	6	12	18																			6	12	18																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	4	0	1	2	1	H7220_004_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	4	0	1	2	1	H7220_004_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	4	0	1	2	1	H7220_004_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	4	0	1	2	1	H7220_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	4	0	1	2	1	H7220_004_0	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	1	1	1	1	H7220_009_1	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	1	1	1	1	H7220_009_1	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	0																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	1	1	1	1	H7220_009_1	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	1	1	1	1	H7220_009_1	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	1	1	1	1	H7220_009_1	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	1	1	1	1	H7220_009_1	4	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	2	1	1	1	H7220_009_2	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	2	1	1	1	H7220_009_2	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	0																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	2	1	1	1	H7220_009_2	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	2	1	1	1	H7220_009_2	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	2	1	1	1	H7220_009_2	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	2	1	1	1	H7220_009_2	4	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	3	1	1	1	H7220_009_3	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	3	6	9																			3	6	0																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	3	1	1	1	H7220_009_3	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	12	24	36																			12	24	0																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	3	1	1	1	H7220_009_3	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	3	1	1	1	H7220_009_3	4	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	100				2	2	30	60	100				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	3	1	1	1	H7220_009_3	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7220	9	3	1	1	1	H7220_009_3	4	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	100				1	2	30	60	100				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7245	1	0	1	1	1	H7245_001_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					4	8	12					4	8	8																15				15			0.5	0.13	0.13			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	1	0	1	1	1	H7245_001_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	36																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	1	0	1	1	1	H7245_001_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	1	0	1	1	1	H7245_001_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											95.14	33	33	33				95.14	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	1	0	1	1	1	H7245_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	27						1	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	2	0	1	1	1	H7245_002_0	9	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					2	4	6					2	4	0																12				12			0.4	0.07	0.07			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	2	0	1	1	1	H7245_002_0	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	30																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	2	0	1	1	1	H7245_002_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	2	0	1	1	1	H7245_002_0	9	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											88.97	33	33	33				88.97	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	2	0	1	1	1	H7245_002_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	29						1	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	3	0	1	1	1	H7245_003_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					4	8	12					4	8	8																12				12			0.4	0.13	0.13			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	3	0	1	1	1	H7245_003_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	36																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	3	0	1	1	1	H7245_003_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	3	0	1	1	1	H7245_003_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											96.69	33	33	33				96.69	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	3	0	1	1	1	H7245_003_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	29						1	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	5	0	1	1	1	H7245_005_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					2	4	6					2	4	0																12				12			0.4	0.07	0.07			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	5	0	1	1	1	H7245_005_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	30																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	5	0	1	1	1	H7245_005_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	5	0	1	1	1	H7245_005_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											96.54	33	33	33				96.54	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	5	0	1	1	1	H7245_005_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	29						1	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	6	0	1	1	1	H7245_006_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								15	30	45					4	8	12					4	8	8																15				15			0.5	0.13	0.13			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	6	0	1	1	1	H7245_006_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	36																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	6	0	1	1	1	H7245_006_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	6	0	1	1	1	H7245_006_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											94.7	33	33	33				94.7	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	6	0	1	1	1	H7245_006_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	27						1	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	8	0	1	1	1	H7245_008_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					2	4	6					2	4	0																12				12			0.4	0.07	0.07			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	8	0	1	1	1	H7245_008_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	30					10	20	30																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	8	0	1	1	1	H7245_008_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	8	0	1	1	1	H7245_008_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											87.09	33	33	33				87.09	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7245	8	0	1	1	1	H7245_008_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	29						1	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	1	0	1	4	1	H7284_001_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	1	0	1	4	1	H7284_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	1	0	1	4	1	H7284_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	1	0	1	4	1	H7284_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	1	0	1	4	1	H7284_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	2	0	1	4	1	H7284_002_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	2	0	1	4	1	H7284_002_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	2	0	1	4	1	H7284_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	2	0	1	4	1	H7284_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	2	0	1	4	1	H7284_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	3	0	1	4	1	H7284_003_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	3	0	1	4	1	H7284_003_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		0				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	3	0	1	4	1	H7284_003_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	3	0	1	4	1	H7284_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7284	3	0	1	4	1	H7284_003_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7301	2	0	1	4	1	H7301_002_0	6	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	2	0	1	4	1	H7301_002_0	6	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	2	0	1	4	1	H7301_002_0	6	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	2	0	1	4	1	H7301_002_0	6	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	2	0	1	4	1	H7301_002_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	2	0	1	4	1	H7301_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	2	0	1	4	1	H7301_002_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											893.06	33						913.56	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	6	0	1	4	1	H7301_006_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	6	0	1	4	1	H7301_006_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	6	0	1	4	1	H7301_006_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	6	0	1	4	1	H7301_006_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	6	0	1	4	1	H7301_006_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	6	0	1	4	1	H7301_006_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	6	0	1	4	1	H7301_006_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											794.28	33						764.53	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	7	0	1	4	1	H7301_007_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	7	0	1	4	1	H7301_007_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	7	0	1	4	1	H7301_007_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	7	0	1	4	1	H7301_007_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	7	0	1	4	1	H7301_007_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	7	0	1	4	1	H7301_007_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	7	0	1	4	1	H7301_007_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											818.93	33						819.27	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	9	0	1	4	1	H7301_009_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	9	0	1	4	1	H7301_009_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	9	0	1	4	1	H7301_009_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	9	0	1	4	1	H7301_009_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7301	9	0	1	4	1	H7301_009_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	9	0	1	4	1	H7301_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7301	9	0	1	4	1	H7301_009_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											739.95	33						696.86	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H7317	1	0	1	1	1	H7317_001_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	4.5	9	13.5																			4.5	4.5	4.5																4.5				4.5		0.15			0.15			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7317	1	0	1	1	1	H7317_001_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	12	24	36																			12	12	12																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7317	1	0	1	1	1	H7317_001_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7317	1	0	1	1	1	H7317_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7317	1	0	1	1	1	H7317_001_0	6	Specialty Tier	4	11	1	1	5	1	111		1	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"												
H7322	1	0	1	1	1	H7322_001_0	5	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	1	0	1	1	1	H7322_001_0	5	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	12		36																			12		36																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	1	0	1	1	1	H7322_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	42		126																			42		126																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	1	0	1	1	1	H7322_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	95		285																			95		285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	1	0	1	1	1	H7322_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				470.15	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	2	0	1	1	1	H7322_002_0	5	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	2	0	1	1	1	H7322_002_0	5	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	15		45																			15		45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	2	0	1	1	1	H7322_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	45		135																			45		135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	2	0	1	1	1	H7322_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	95		285																			95		285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7322	2	0	1	1	1	H7322_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				502.35	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	1	0	1	4	1	H7323_001_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	1	0	1	4	1	H7323_001_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	1	0	1	4	1	H7323_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	1	0	1	4	1	H7323_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.39	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	1	0	1	4	1	H7323_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	2	0	1	4	1	H7323_002_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	2	0	1	4	1	H7323_002_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	2	0	1	4	1	H7323_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	2	0	1	4	1	H7323_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.39	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	2	0	1	4	1	H7323_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	3	0	1	4	1	H7323_003_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	3	0	1	4	1	H7323_003_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7323	3	0	1	4	1	H7323_003_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	3	0	1	4	1	H7323_003_0	5	Generic	4	11	1	2	2	3	110		1		110	1	30		90				1	2				30		90	30		31	8		24																									8		24				8		0				8				8		0.27				0.27	0.27	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7323	3	0	1	4	1	H7323_003_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	3	0	1	4	1	H7323_003_0	5	Preferred Brand	4	11	1	2	3	3	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	1	
H7323	3	0	1	4	1	H7323_003_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				89.67	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	3	0	1	4	1	H7323_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					29																										29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	4	0	1	4	1	H7323_004_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	4	0	1	4	1	H7323_004_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	4	0	1	4	1	H7323_004_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	4	0	1	4	1	H7323_004_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				77.4	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7323	4	0	1	4	1	H7323_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					28																										28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	1	0	1	4	1	H7326_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	1	0	1	4	1	H7326_001_0	6	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H7326	1	0	1	4	1	H7326_001_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	1	0	1	4	1	H7326_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	1	0	1	4	1	H7326_001_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				66.32	35		35																								35		35				35		35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	1	0	1	4	1	H7326_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	2	0	1	4	1	H7326_002_0	6	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	2	0	1	4	1	H7326_002_0	6	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	2	0	1	4	1	H7326_002_0	6	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	2	0	1	4	1	H7326_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				64.51	35		35																								35		35				35		35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	2	0	1	4	1	H7326_002_0	6	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	3	0	1	4	1	H7326_003_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	3	0	1	4	1	H7326_003_0	7	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H7326	3	0	1	4	1	H7326_003_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	3	0	1	4	1	H7326_003_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	3	0	1	4	1	H7326_003_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	3	0	1	4	1	H7326_003_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	4	0	1	4	1	H7326_004_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	4	0	1	4	1	H7326_004_0	7	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7326	4	0	1	4	1	H7326_004_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	9		27																									9		27				9		0				9				9		0.3				0.3	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	4	0	1	4	1	H7326_004_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	4	0	1	4	1	H7326_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7326	4	0	1	4	1	H7326_004_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7330	1	0	1	1	1	H7330_001_0	7	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	12.5																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7330	1	0	1	1	1	H7330_001_0	7	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	37.5																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7330	1	0	1	1	1	H7330_001_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7330	1	0	1	1	1	H7330_001_0	7	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	95	190	285																			95	190	237.5																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7330	1	0	1	1	1	H7330_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				603.4	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7330	1	0	1	1	1	H7330_001_0	7	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	1	0	1	1	1	H7394_001_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	1	0	1	1	1	H7394_001_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		24																					20																8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	1	0	1	1	1	H7394_001_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					100																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	1	0	1	1	1	H7394_001_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	1	0	1	1	1	H7394_001_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	1	0	1	1	1	H7394_001_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	1	0	1	1	1	H7394_001_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	2	0	1	1	1	H7394_002_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		9																					7.5																3				3		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	2	0	1	1	1	H7394_002_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					25																10				10		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	2	0	1	1	1	H7394_002_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	2	0	1	1	1	H7394_002_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	100		300																					250																100				100		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	2	0	1	1	1	H7394_002_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	2	0	1	1	1	H7394_002_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	2	0	1	1	1	H7394_002_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	3	0	1	1	1	H7394_003_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	3	0	1	1	1	H7394_003_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		24																					20																8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	3	0	1	1	1	H7394_003_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					100																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	3	0	1	1	1	H7394_003_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	3	0	1	1	1	H7394_003_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	3	0	1	1	1	H7394_003_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	3	0	1	1	1	H7394_003_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	4	0	1	1	1	H7394_004_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		9																					7.5																3				3		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	4	0	1	1	1	H7394_004_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					25																10				10		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	4	0	1	1	1	H7394_004_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	4	0	1	1	1	H7394_004_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	100		300																					250																100				100		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	4	0	1	1	1	H7394_004_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	4	0	1	1	1	H7394_004_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	4	0	1	1	1	H7394_004_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	5	0	1	1	1	H7394_005_0	8	Preferred Generic	4	1	3	1	1	1	110		1	100		1	30		90				1	2			90				30		31				1.3	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	5	0	1	1	1	H7394_005_0	8	Generic	4	1	1	1	2	1	110		1	100		1	30		90				1	2			90				30		31				1.3	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	5	0	1	1	1	H7394_005_0	8	Preferred Brand	4	10	1	1	3	1	110		1	100		1	30		90				1	2			90				30		31				3.9	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	5	0	1	1	1	H7394_005_0	8	Non-Preferred Brand	4	10	1	1	4	1	110		1	100		1	30		90				1	1			90				30		31				3.9	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	5	0	1	1	1	H7394_005_0	8	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	5	0	1	1	1	H7394_005_0	8	Select Care Drugs	4	11	1	1	6	1	110		1	100		1	30		90				1	2			90				30		31				0	0		0																				0															0			0								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	5	0	1	1	1	H7394_005_0	8	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	6	0	1	1	1	H7394_006_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	6	0	1	1	1	H7394_006_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					25																10				10		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	6	0	1	1	1	H7394_006_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					100																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	6	0	1	1	1	H7394_006_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	6	0	1	1	1	H7394_006_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	6	0	1	1	1	H7394_006_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	6	0	1	1	1	H7394_006_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	7	0	1	1	1	H7394_007_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		9																					7.5																3				3		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	7	0	1	1	1	H7394_007_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		45																					37.5																15				15		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	7	0	1	1	1	H7394_007_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	7	0	1	1	1	H7394_007_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	100		300																					250																100				100		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	7	0	1	1	1	H7394_007_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	7	0	1	1	1	H7394_007_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	7	0	1	1	1	H7394_007_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	8	0	1	1	1	H7394_008_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	8	0	1	1	1	H7394_008_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					25																10				10		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	8	0	1	1	1	H7394_008_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					100																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	8	0	1	1	1	H7394_008_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	8	0	1	1	1	H7394_008_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	8	0	1	1	1	H7394_008_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	8	0	1	1	1	H7394_008_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	9	0	1	1	1	H7394_009_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		9																					7.5																3				3		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	9	0	1	1	1	H7394_009_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	12		36																					30																12				12		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	9	0	1	1	1	H7394_009_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	9	0	1	1	1	H7394_009_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	100		300																					250																100				100		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	9	0	1	1	1	H7394_009_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	9	0	1	1	1	H7394_009_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	9	0	1	1	1	H7394_009_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	10	0	1	1	1	H7394_010_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	10	0	1	1	1	H7394_010_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	12		36																					30																12				12		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	10	0	1	1	1	H7394_010_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					100																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	10	0	1	1	1	H7394_010_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	10	0	1	1	1	H7394_010_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	10	0	1	1	1	H7394_010_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	10	0	1	1	1	H7394_010_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	11	0	1	1	1	H7394_011_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		9																					7.5																3				3		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	11	0	1	1	1	H7394_011_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	15		45																					37.5																15				15		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	11	0	1	1	1	H7394_011_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	11	0	1	1	1	H7394_011_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	100		300																					250																100				100		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	11	0	1	1	1	H7394_011_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	11	0	1	1	1	H7394_011_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	11	0	1	1	1	H7394_011_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	12	0	1	1	1	H7394_012_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	12	0	1	1	1	H7394_012_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					25																10				10		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	12	0	1	1	1	H7394_012_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	40		120																					100																40				40		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	12	0	1	1	1	H7394_012_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	90		270																					225																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	12	0	1	1	1	H7394_012_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					30		30																		30		30															30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	12	0	1	1	1	H7394_012_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	12	0	1	1	1	H7394_012_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7394	13	0	1	1	1	H7394_013_0	10	Preferred Generic	4	1	3	2	1	1	110		1	100		1	30		90				1	2			90				30		31	3		9																					7.5																3				3		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	13	0	1	1	1	H7394_013_0	10	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					25																10				10		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	13	0	1	1	1	H7394_013_0	10	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					117.5																47				47		1.33						1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	13	0	1	1	1	H7394_013_0	10	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				1	1			90				30		31	100		300																					250																100				100		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	13	0	1	1	1	H7394_013_0	10	Specialty Tier	4	10	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	13	0	1	1	1	H7394_013_0	10	Select Care Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H7394	13	0	1	1	1	H7394_013_0	10	Select Care Drugs	4	11	1	2	6	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H7399	1	0	1	1	1	H7399_001_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	4																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	1	0	1	1	1	H7399_001_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	1	0	1	1	1	H7399_001_0	3	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	1	0	1	1	1	H7399_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	1	0	1	1	1	H7399_001_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	1	0	1	1	1	H7399_001_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	2	0	1	1	1	H7399_002_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	4																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	2	0	1	1	1	H7399_002_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	2	0	1	1	1	H7399_002_0	3	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	2	0	1	1	1	H7399_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	2	0	1	1	1	H7399_002_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7399	2	0	1	1	1	H7399_002_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7404	1	0	1	4	1	H7404_001_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	1	0	1	4	1	H7404_001_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	1	0	1	4	1	H7404_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	1	0	1	4	1	H7404_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	1	0	1	4	1	H7404_001_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				581	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	2	0	1	4	1	H7404_002_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	2	0	1	4	1	H7404_002_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	2	0	1	4	1	H7404_002_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	2	0	1	4	1	H7404_002_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	2	0	1	4	1	H7404_002_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				628	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	4	0	1	4	1	H7404_004_0	7	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	4	0	1	4	1	H7404_004_0	7	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	4	0	1	4	1	H7404_004_0	7	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	4	0	1	4	1	H7404_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	4	0	1	4	1	H7404_004_0	7	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				632	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	5	0	1	4	1	H7404_005_0	8	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	5	0	1	4	1	H7404_005_0	8	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	5	0	1	4	1	H7404_005_0	8	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	5	0	1	4	1	H7404_005_0	8	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	5	0	1	4	1	H7404_005_0	8	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				576	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	6	0	1	4	1	H7404_006_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	6	0	1	4	1	H7404_006_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	6	0	1	4	1	H7404_006_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	6	0	1	4	1	H7404_006_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	6	0	1	4	1	H7404_006_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				641	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	11	0	1	4	1	H7404_011_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	11	0	1	4	1	H7404_011_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	11	0	1	4	1	H7404_011_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	11	0	1	4	1	H7404_011_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	11	0	1	4	1	H7404_011_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				581	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	12	0	1	4	1	H7404_012_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	12	0	1	4	1	H7404_012_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	12	0	1	4	1	H7404_012_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	12	0	1	4	1	H7404_012_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	12	0	1	4	1	H7404_012_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				628	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	14	0	1	4	1	H7404_014_0	6	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	14	0	1	4	1	H7404_014_0	6	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	14	0	1	4	1	H7404_014_0	6	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	14	0	1	4	1	H7404_014_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7404	14	0	1	4	1	H7404_014_0	6	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				651	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7409	1	0	1	1	1	H7409_001_0	7	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	1	0	1	1	1	H7409_001_0	7	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	1	0	1	1	1	H7409_001_0	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	1	0	1	1	1	H7409_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	1	0	1	1	1	H7409_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											757.74	33						757.74	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	1	0	1	1	1	H7409_001_0	7	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	1	0	1	1	1	H7409_001_0	7	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7409	2	0	1	1	1	H7409_002_0	7	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	2	0	1	1	1	H7409_002_0	7	Generic	4	11	1	1	2	1		110	1	110		1				30		90	1	2	30		90				30		31											10.74	25		25				10.74	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	2	0	1	1	1	H7409_002_0	7	Preferred Brand	4	11	1	1	3	1		110	1	110		1				30		90	1	2	30		90				30		31											60.88	25		25				60.88	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	2	0	1	1	1	H7409_002_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											76.96	25		25				76.96	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	2	0	1	1	1	H7409_002_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											675.83	25						675.83	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	2	0	1	1	1	H7409_002_0	7	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7409	2	0	1	1	1	H7409_002_0	7	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7419	1	0	1	48	5	H7419_001_0	2	$0 Drugs	4	11			1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H7419	1	0	1	48	5	H7419_001_0	2	Generic Drugs	4	1			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H7419	1	0	1	48	5	H7419_001_0	2	Brand Drugs	4	10			3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H7419	1	0	1	48	5	H7419_001_0	2	Non-Medicare Rx/OTC Drugs	4	11			4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H7511	2	0	1	1	1	H7511_002_0	7	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4	8	12																																						4			4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7511	2	0	1	1	1	H7511_002_0	7	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7511	2	0	1	1	1	H7511_002_0	7	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7511	2	0	1	1	1	H7511_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7511	2	0	1	1	1	H7511_002_0	7	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7518	1	0	1	4	1	H7518_001_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7518	1	0	1	4	1	H7518_001_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	5		15																									5		15				5		0				5				5		0.17				0.17	0.17	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7518	1	0	1	4	1	H7518_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7518	1	0	1	4	1	H7518_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		110	1	30		90				1	2				30		90	30		31	100		300																									100		300				100		200				100				100		3.33				3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7518	1	0	1	4	1	H7518_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7522	1	0	1	4	1	H7522_001_0	8	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7522	1	0	1	4	1	H7522_001_0	8	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				2	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H7522	1	0	1	4	1	H7522_001_0	8	Generic	4	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	5		10																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7522	1	0	1	4	1	H7522_001_0	8	Generic	4	1	1	2	2	3	110		1	100		1	30		90				2	2			90				30		31	5		10																					10																5				5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										2		
H7522	1	0	1	4	1	H7522_001_0	8	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	35		70																					70																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7522	1	0	1	4	1	H7522_001_0	8	Non-Preferred Brand	4	10	1	2	4	1	110		1	100		1	30		90				2	2			90				30		31	50		100																					100																50				50		1.67						1.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7522	1	0	1	4	1	H7522_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				273.12	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7621	1	0	1	1	1	H7621_001_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	1	0	1	1	1	H7621_001_0	3	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	1	0	1	1	1	H7621_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	1	0	1	1	1	H7621_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	1	0	1	1	1	H7621_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	2	0	1	1	1	H7621_002_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	2	0	1	1	1	H7621_002_0	2	Preferred Generic	4	11	3	2	1	3		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H7621	2	0	1	1	1	H7621_002_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	2	0	1	1	1	H7621_002_0	2	Generic	4	11	1	2	2	3		110	1		110	1				30		90	2	2				30		90	30		31								20		60					5		15											20		60				5		0				20				20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7621	2	0	1	1	1	H7621_002_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		94				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	2	0	1	1	1	H7621_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	2	0	1	1	1	H7621_002_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	3	0	1	1	1	H7621_003_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	3	0	1	1	1	H7621_003_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					10		30											20		60				10		0				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	3	0	1	1	1	H7621_003_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		94				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	3	0	1	1	1	H7621_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		200				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7621	3	0	1	1	1	H7621_003_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	1	0	1	2	1	H7646_001_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	1	0	1	2	1	H7646_001_0	7	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	1	0	1	2	1	H7646_001_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					40	80	120					45	90	112.5																45				45			1.5	1.33	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	1	0	1	2	1	H7646_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	285					90	180	270					95	190	237.5																95				95			3.17	3	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	1	0	1	2	1	H7646_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	2	0	1	2	1	H7646_002_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	2	0	1	2	1	H7646_002_0	7	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	2	0	1	2	1	H7646_002_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					40	80	120					45	90	112.5																45				45			1.5	1.33	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	2	0	1	2	1	H7646_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	285					90	180	270					95	190	237.5																95				95			3.17	3	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	2	0	1	2	1	H7646_002_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	3	0	1	2	1	H7646_003_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	3	0	1	2	1	H7646_003_0	7	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	3	0	1	2	1	H7646_003_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					40	80	120					45	90	112.5																45				45			1.5	1.33	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	3	0	1	2	1	H7646_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	285					90	180	270					95	190	237.5																95				95			3.17	3	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	3	0	1	2	1	H7646_003_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	4	0	1	2	1	H7646_004_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	4	0	1	2	1	H7646_004_0	7	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	4	0	1	2	1	H7646_004_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					40	80	120					45	90	112.5																45				45			1.5	1.33	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	4	0	1	2	1	H7646_004_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	285					90	180	270					95	190	237.5																95				95			3.17	3	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	4	0	1	2	1	H7646_004_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	5	0	1	2	1	H7646_005_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	5	0	1	2	1	H7646_005_0	7	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	5	0	1	2	1	H7646_005_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					40	80	120					45	90	112.5																45				45			1.5	1.33	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	5	0	1	2	1	H7646_005_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	285					90	180	270					95	190	237.5																95				95			3.17	3	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	5	0	1	2	1	H7646_005_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	6	0	1	2	1	H7646_006_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	6	0	1	2	1	H7646_006_0	7	Generic	4	11	3	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	6	0	1	2	1	H7646_006_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								45	90	135					40	80	120					45	90	112.5																45				45			1.5	1.33	1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	6	0	1	2	1	H7646_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								95	190	285					90	180	270					95	190	237.5																95				95			3.17	3	3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7646	6	0	1	2	1	H7646_006_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											632.86	33						632.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7678	1	0	1	1	1	H7678_001_0	8	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7678	1	0	1	1	1	H7678_001_0	8	Preferred Generic	4	11	1	2	1	3	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7678	1	0	1	1	1	H7678_001_0	8	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	5	10	15																			5	10	15																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7678	1	0	1	1	1	H7678_001_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	42	84	126																			42	84	126																42				42		1.35			1.35			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7678	1	0	1	1	1	H7678_001_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				93.7	40	40	40																		40	40	40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7678	1	0	1	1	1	H7678_001_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				536.86	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7680	1	0	1	2	1	H7680_001_0	13	Preferred Generic	4	11	3	2	1	1	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	1	0	1	2	1	H7680_001_0	13	Preferred Generic	4	11	3	2	1	3	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H7680	1	0	1	2	1	H7680_001_0	13	Generic	4	11	1	2	2	1	111		1	100		1	30	60	100				1	2			100				30		31	13	26	26																					26																13				13		0.43						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	1	0	1	2	1	H7680_001_0	13	Generic	4	11	1	2	2	3	111		1	100		1	30	60	100				1	2			100				30		31	13	26	26																					26																13				13		0.43						0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7680	1	0	1	2	1	H7680_001_0	13	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	100				1	2			100				30		31	35	70	105																					105																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	1	0	1	2	1	H7680_001_0	13	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	100				1	2			100				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	1	0	1	2	1	H7680_001_0	13	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	1	0	1	2	1	H7680_001_0	13	Select Care Drugs	4	11	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	1	0	1	2	1	H7680_001_0	13	Select Care Drugs	4	11	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7680	2	0	1	2	1	H7680_002_0	13	Preferred Generic	4	11	3	2	1	1	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	2	0	1	2	1	H7680_002_0	13	Preferred Generic	4	11	3	2	1	3	111		1	100		1	30	60	100				1	2			100				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H7680	2	0	1	2	1	H7680_002_0	13	Generic	4	11	1	2	2	1	111		1	100		1	30	60	100				1	2			100				30		31	12	24	24																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	2	0	1	2	1	H7680_002_0	13	Generic	4	11	1	2	2	3	111		1	100		1	30	60	100				1	2			100				30		31	12	24	24																					24																12				12		0.4						0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7680	2	0	1	2	1	H7680_002_0	13	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	100				1	2			100				30		31	35	70	105																					105																35				35		1.17						1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	2	0	1	2	1	H7680_002_0	13	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	100				1	2			100				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	2	0	1	2	1	H7680_002_0	13	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				670	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	2	0	1	2	1	H7680_002_0	13	Select Care Drugs	4	11	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7680	2	0	1	2	1	H7680_002_0	13	Select Care Drugs	4	11	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0	0	0																					0																	0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7728	2	0	1	4	1	H7728_002_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	2	0	1	4	1	H7728_002_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	2	0	1	4	1	H7728_002_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								46	92	138					41	82	123					41	82	82																46				46			1.53	1.37	1.37			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	2	0	1	4	1	H7728_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	2	0	1	4	1	H7728_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	2	0	1	4	1	H7728_002_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	2	0	1	4	1	H7728_002_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7728	4	1	1	4	1	H7728_004_1	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	1	1	4	1	H7728_004_1	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	24	24																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	1	1	4	1	H7728_004_1	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	1	1	4	1	H7728_004_1	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	1	1	4	1	H7728_004_1	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	1	1	4	1	H7728_004_1	5	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	1	1	4	1	H7728_004_1	5	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7728	4	2	1	4	1	H7728_004_2	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	6	6																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	2	1	4	1	H7728_004_2	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	24	24																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	2	1	4	1	H7728_004_2	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	2	1	4	1	H7728_004_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	2	1	4	1	H7728_004_2	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	2	1	4	1	H7728_004_2	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	4	2	1	4	1	H7728_004_2	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7728	5	0	1	4	1	H7728_005_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	5	0	1	4	1	H7728_005_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								18	36	54					13	26	39					13	26	26																18				18			0.6	0.43	0.43			0.53	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	5	0	1	4	1	H7728_005_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	5	0	1	4	1	H7728_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	5	0	1	4	1	H7728_005_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	5	0	1	4	1	H7728_005_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	5	0	1	4	1	H7728_005_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7728	6	0	1	4	1	H7728_006_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	6	0	1	4	1	H7728_006_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								18	36	54					13	26	39					13	26	26																18				18			0.6	0.43	0.43			0.53	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	6	0	1	4	1	H7728_006_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	6	0	1	4	1	H7728_006_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	6	0	1	4	1	H7728_006_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	6	0	1	4	1	H7728_006_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7728	6	0	1	4	1	H7728_006_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7787	1	0	1	4	1	H7787_001_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7787	1	0	1	4	1	H7787_001_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7787	1	0	1	4	1	H7787_001_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7787	1	0	1	4	1	H7787_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7787	1	0	1	4	1	H7787_001_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											970.81	33						728.23	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7802	1	0	1	1	1	H7802_001_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	1	0	1	1	1	H7802_001_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	1	0	1	1	1	H7802_001_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	1	0	1	1	1	H7802_001_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	1	0	1	1	1	H7802_001_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	2	0	1	1	1	H7802_002_0	8	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	2	0	1	1	1	H7802_002_0	8	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	2	0	1	1	1	H7802_002_0	8	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	2	0	1	1	1	H7802_002_0	8	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	2	0	1	1	1	H7802_002_0	8	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	3	0	1	1	1	H7802_003_0	9	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	5	10	15																																						5			5		0.17						0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	3	0	1	1	1	H7802_003_0	9	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	3	0	1	1	1	H7802_003_0	9	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	3	0	1	1	1	H7802_003_0	9	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	100	200	300																																						100			100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7802	3	0	1	1	1	H7802_003_0	9	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H7833	1	0	1	48	5	H7833_001_0	6	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6	0	3.6	0	3.6	0	3.6			
H7833	1	0	1	48	5	H7833_001_0	6	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95	0	8.95	0	8.95	0	8.95			
H7833	1	0	1	48	5	H7833_001_0	6	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H7844	1	0	1	48	5	H7844_001_0	5	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H7844	1	0	1	48	5	H7844_001_0	5	Brand Drugs	4	11			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H7844	1	0	1	48	5	H7844_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	10		1	10		1	31								31						31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H7849	1	0	1	4	1	H7849_001_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	1	0	1	4	1	H7849_001_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	1	0	1	4	1	H7849_001_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	1	0	1	4	1	H7849_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	1	0	1	4	1	H7849_001_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											908.08	33						1017.17	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	2	0	1	4	1	H7849_002_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	2	0	1	4	1	H7849_002_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	2	0	1	4	1	H7849_002_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	2	0	1	4	1	H7849_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	2	0	1	4	1	H7849_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											908.08	33						1017.17	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	3	0	1	4	1	H7849_003_0	10	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	5											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	3	0	1	4	1	H7849_003_0	10	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	10											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	3	0	1	4	1	H7849_003_0	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	3	0	1	4	1	H7849_003_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	3	0	1	4	1	H7849_003_0	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											805.79	31						808.36	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	6	0	1	4	1	H7849_006_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	6	0	1	4	1	H7849_006_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	6	0	1	4	1	H7849_006_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	6	0	1	4	1	H7849_006_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	6	0	1	4	1	H7849_006_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											970.94	33						800.88	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	7	0	1	4	1	H7849_007_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	7	0	1	4	1	H7849_007_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	7	0	1	4	1	H7849_007_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	7	0	1	4	1	H7849_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	7	0	1	4	1	H7849_007_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											970.94	33						800.88	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	8	0	1	4	1	H7849_008_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	8	0	1	4	1	H7849_008_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	8	0	1	4	1	H7849_008_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	8	0	1	4	1	H7849_008_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	8	0	1	4	1	H7849_008_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											932.46	33						843.5	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	9	0	1	4	1	H7849_009_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	9	0	1	4	1	H7849_009_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	9	0	1	4	1	H7849_009_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	9	0	1	4	1	H7849_009_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	9	0	1	4	1	H7849_009_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											932.46	33						843.5	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	10	0	1	4	1	H7849_010_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	12.5					0	0	0											5	10	12.5				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	10	0	1	4	1	H7849_010_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	22.5					4	8	10											9	18	22.5				0	0	0				9				9			0.3	0.13		0.3	0	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	10	0	1	4	1	H7849_010_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	10	0	1	4	1	H7849_010_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								85	170	255					80	160	240											85	170	255				80	160	240				85				85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	10	0	1	4	1	H7849_010_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											969.02	33						941.92	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	11	0	1	4	1	H7849_011_0	9	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	11	0	1	4	1	H7849_011_0	9	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	45					10	20	25											15	30	45				10	20	0				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	11	0	1	4	1	H7849_011_0	9	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	11	0	1	4	1	H7849_011_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	11	0	1	4	1	H7849_011_0	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											959.99	33						879.38	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	12	0	1	4	1	H7849_012_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	5											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	12	0	1	4	1	H7849_012_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	10											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	12	0	1	4	1	H7849_012_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	12	0	1	4	1	H7849_012_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	12	0	1	4	1	H7849_012_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											992.19	33						855.22	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	13	0	1	4	1	H7849_013_0	8	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	5											7	14	21				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	13	0	1	4	1	H7849_013_0	8	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	10											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	13	0	1	4	1	H7849_013_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								45	90	135					40	80	120											45	90	135				40	80	120				45				45			1.5	1.33		1.5	1.33	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	13	0	1	4	1	H7849_013_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7849	13	0	1	4	1	H7849_013_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											992.19	33						855.22	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7853	1	0	1	1	1	H7853_001_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	1	0	1	1	1	H7853_001_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	1	0	1	1	1	H7853_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	1	0	1	1	1	H7853_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	1	0	1	1	1	H7853_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				903.83	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	1	0	1	1	1	H7853_001_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	1	0	1	1	1	H7853_001_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7853	2	0	1	1	1	H7853_002_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	2	0	1	1	1	H7853_002_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	2	0	1	1	1	H7853_002_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	2	0	1	1	1	H7853_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	2	0	1	1	1	H7853_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				625.19	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	2	0	1	1	1	H7853_002_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	2	0	1	1	1	H7853_002_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7853	3	0	1	2	1	H7853_003_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	3	0	1	2	1	H7853_003_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	3	0	1	2	1	H7853_003_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	3	0	1	2	1	H7853_003_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	3	0	1	2	1	H7853_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				739.08	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	3	0	1	2	1	H7853_003_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	3	0	1	2	1	H7853_003_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7853	4	0	1	2	1	H7853_004_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	4	0	1	2	1	H7853_004_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	4	0	1	2	1	H7853_004_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	4	0	1	2	1	H7853_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	4	0	1	2	1	H7853_004_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				758.33	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	4	0	1	2	1	H7853_004_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	4	0	1	2	1	H7853_004_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7853	5	0	1	1	1	H7853_005_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	5	0	1	1	1	H7853_005_0	6	Generic	4	11	1	1	2	1	110		1	110		1	30		90				1	2	30		90				30		31				11.34	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	5	0	1	1	1	H7853_005_0	6	Preferred Brand	4	11	1	1	3	1	110		1	110		1	30		90				1	2	30		90				30		31				61.36	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	5	0	1	1	1	H7853_005_0	6	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				1	2	30		90				30		31				78.84	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	5	0	1	1	1	H7853_005_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				676.97	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	5	0	1	1	1	H7853_005_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	5	0	1	1	1	H7853_005_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7853	6	0	1	1	1	H7853_006_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	6	0	1	1	1	H7853_006_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	6	0	1	1	1	H7853_006_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	6	0	1	1	1	H7853_006_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	6	0	1	1	1	H7853_006_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											748.91	31						748.91	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	6	0	1	1	1	H7853_006_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	6	0	1	1	1	H7853_006_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7853	7	0	1	1	1	H7853_007_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	7	0	1	1	1	H7853_007_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	7	0	1	1	1	H7853_007_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	7	0	1	1	1	H7853_007_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	7	0	1	1	1	H7853_007_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											771.98	33						771.98	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	7	0	1	1	1	H7853_007_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	7	0	1	1	1	H7853_007_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7853	8	0	1	1	1	H7853_008_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	8	0	1	1	1	H7853_008_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		40					10		20					10		20																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	8	0	1	1	1	H7853_008_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	8	0	1	1	1	H7853_008_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	8	0	1	1	1	H7853_008_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											753.27	33						753.27	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	8	0	1	1	1	H7853_008_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H7853	8	0	1	1	1	H7853_008_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H7885	1	0	1	48	5	H7885_001_0	3	Generic Drugs	4	1			1	1	110		1			1	31		93				2	2							31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6	0	3.6			0	3.6			
H7885	1	0	1	48	5	H7885_001_0	3	Brand Drugs	4	10			2	1	110		1			1	31		93				2	2							31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95	0	8.95			0	8.95			
H7885	1	0	1	48	5	H7885_001_0	3	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		1			1	31		93				1	2							31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0			0	0			
H7890	1	0	1	48	5	H7890_001_0	8	Generic Drugs	4	1			1	1	111		1	100		1	31	60	90				2	2			90				31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H7890	1	0	1	48	5	H7890_001_0	8	Brand Drugs	4	10			2	1	111		1	100		1	31	60	90				2	2			90				31		31																																														0.28						0.28	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	8.95	0	8.95	0	8.95	0	8.95			
H7890	1	0	1	48	5	H7890_001_0	8	Non-Medicare Rx Drugs	4	11			3	1	111		1	100		1	31	60	90				1	2			90				31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H7890	1	0	1	48	5	H7890_001_0	8	Non-Medicare OTC Drugs	4	11			4	1	111		1	100		1	31	60	90				1	2			90				31		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H7917	8	0	1	4	1	H7917_008_0	6	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	8	0	1	4	1	H7917_008_0	6	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	8	0	1	4	1	H7917_008_0	6	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	8	0	1	4	1	H7917_008_0	6	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	8	0	1	4	1	H7917_008_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55	110	145					50	100	125											55	110	145				50	100	125					55			55			1.83	1.67		1.83	1.67	1.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	8	0	1	4	1	H7917_008_0	6	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	9	0	1	4	1	H7917_009_0	4	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	9	0	1	4	1	H7917_009_0	4	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	9	0	1	4	1	H7917_009_0	4	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	9	0	1	4	1	H7917_009_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	9	0	1	4	1	H7917_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55	110	145					50	100	125											55	110	145				50	100	125					55			55			1.83	1.67		1.83	1.67	1.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	9	0	1	4	1	H7917_009_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	10	0	1	4	1	H7917_010_0	4	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	10	0	1	4	1	H7917_010_0	4	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	10	0	1	4	1	H7917_010_0	4	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	10	0	1	4	1	H7917_010_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	10	0	1	4	1	H7917_010_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55	110	145					50	100	125											55	110	145				50	100	125					55			55			1.83	1.67		1.83	1.67	1.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	10	0	1	4	1	H7917_010_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	11	0	1	4	1	H7917_011_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	11	0	1	4	1	H7917_011_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	11	0	1	4	1	H7917_011_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	11	0	1	4	1	H7917_011_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	11	0	1	4	1	H7917_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55	110	145					50	100	125											55	110	145				50	100	125					55			55			1.83	1.67		1.83	1.67	1.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	11	0	1	4	1	H7917_011_0	7	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	12	0	1	4	1	H7917_012_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	12	0	1	4	1	H7917_012_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	12	0	1	4	1	H7917_012_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	12	0	1	4	1	H7917_012_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	12	0	1	4	1	H7917_012_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70	140	185					65	130	165											70	140	185				65	130	165					70			70			2.33	2.17		2.33	2.17	2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	12	0	1	4	1	H7917_012_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	13	0	1	4	1	H7917_013_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	13	0	1	4	1	H7917_013_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	13	0	1	4	1	H7917_013_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	13	0	1	4	1	H7917_013_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	13	0	1	4	1	H7917_013_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70	140	185					65	130	165											70	140	185				65	130	165					70			70			2.33	2.17		2.33	2.17	2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	13	0	1	4	1	H7917_013_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	14	0	1	4	1	H7917_014_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	14	0	1	4	1	H7917_014_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	14	0	1	4	1	H7917_014_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	14	0	1	4	1	H7917_014_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	14	0	1	4	1	H7917_014_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70	140	185					65	130	165											70	140	185				65	130	165					70			70			2.33	2.17		2.33	2.17	2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	14	0	1	4	1	H7917_014_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	15	0	1	4	1	H7917_015_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	15	0	1	4	1	H7917_015_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	15	0	1	4	1	H7917_015_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	15	0	1	4	1	H7917_015_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33	66	95					28	56	70											33	66	95				28	56	70					33			33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	15	0	1	4	1	H7917_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70	140	185					65	130	165											70	140	185				65	130	165					70			70			2.33	2.17		2.33	2.17	2.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	15	0	1	4	1	H7917_015_0	7	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	30	0	1	4	1	H7917_030_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	30	0	1	4	1	H7917_030_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	30	0	1	4	1	H7917_030_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	30	35					10	10	10											15	30	35				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	30	0	1	4	1	H7917_030_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	94	135					42	84	105											47	94	135				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	30	0	1	4	1	H7917_030_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	194	285					92	184	225											97	194	285				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	30	0	1	4	1	H7917_030_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	31	0	1	4	1	H7917_031_0	7	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	31	0	1	4	1	H7917_031_0	7	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	31	0	1	4	1	H7917_031_0	7	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	30	35					10	10	10											15	30	35				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	31	0	1	4	1	H7917_031_0	7	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	94	135					42	84	105											47	94	135				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	31	0	1	4	1	H7917_031_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	194	285					92	184	225											97	194	285				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	31	0	1	4	1	H7917_031_0	7	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	32	0	1	4	1	H7917_032_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	32	0	1	4	1	H7917_032_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	32	0	1	4	1	H7917_032_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	30	35					10	10	10											15	30	35				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	32	0	1	4	1	H7917_032_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	94	135					42	84	105											47	94	135				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	32	0	1	4	1	H7917_032_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	194	285					92	184	225											97	194	285				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	32	0	1	4	1	H7917_032_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	33	0	1	4	1	H7917_033_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	33	0	1	4	1	H7917_033_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	33	0	1	4	1	H7917_033_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15	30	35					10	10	10											15	30	35				10	10	10					15			15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	33	0	1	4	1	H7917_033_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47	94	135					42	84	105											47	94	135				42	84	105					47			47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	33	0	1	4	1	H7917_033_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97	194	285					92	184	225											97	194	285				92	184	225					97			97			3.23	3.07		3.23	3.07	3.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	33	0	1	4	1	H7917_033_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	34	0	1	4	1	H7917_034_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	34	0	1	4	1	H7917_034_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	34	0	1	4	1	H7917_034_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	34	0	1	4	1	H7917_034_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40	80	100					35	70	90											40	80	100				35	70	90					40			40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	34	0	1	4	1	H7917_034_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85	170	215					80	160	200											85	170	215				80	160	200					85			85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	34	0	1	4	1	H7917_034_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	35	0	1	4	1	H7917_035_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	35	0	1	4	1	H7917_035_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	35	0	1	4	1	H7917_035_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	35	0	1	4	1	H7917_035_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40	80	100					35	70	90											40	80	100				35	70	90					40			40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	35	0	1	4	1	H7917_035_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85	170	215					80	160	200											85	170	215				80	160	200					85			85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	35	0	1	4	1	H7917_035_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	36	0	1	4	1	H7917_036_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	36	0	1	4	1	H7917_036_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	36	0	1	4	1	H7917_036_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	36	0	1	4	1	H7917_036_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40	80	100					35	70	90											40	80	100				35	70	90					40			40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	36	0	1	4	1	H7917_036_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85	170	215					80	160	200											85	170	215				80	160	200					85			85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	36	0	1	4	1	H7917_036_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	37	0	1	4	1	H7917_037_0	5	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	37	0	1	4	1	H7917_037_0	5	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6	12	15					1	1	1											6	12	15				1	1	1					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7917	37	0	1	4	1	H7917_037_0	5	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10	20	25					5	5	5											10	20	25				5	5	5					10			10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	37	0	1	4	1	H7917_037_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40	80	100					35	70	90											40	80	100				35	70	90					40			40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	37	0	1	4	1	H7917_037_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85	170	215					80	160	200											85	170	215				80	160	200					85			85			2.83	2.67		2.83	2.67	2.74	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7917	37	0	1	4	1	H7917_037_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				14	31												33							33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	1	0	1	1	1	H7993_001_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	1	0	1	1	1	H7993_001_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7993	1	0	1	1	1	H7993_001_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	1	0	1	1	1	H7993_001_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H7993	1	0	1	1	1	H7993_001_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	80																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	1	0	1	1	1	H7993_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	80	160	240																			80	160	160																80				80		2.67			2.67			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	1	0	1	1	1	H7993_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	2	0	1	1	1	H7993_002_0	5	Preferred Generic	4	11	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	2	0	1	1	1	H7993_002_0	5	Preferred Generic	4	11	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H7993	2	0	1	1	1	H7993_002_0	5	Generic	4	11	3	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	2	0	1	1	1	H7993_002_0	5	Generic	4	11	3	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		3
H7993	2	0	1	1	1	H7993_002_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	30	60	90																			30	60	60																30				30		1			1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	2	0	1	1	1	H7993_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	80	160	240																			80	160	160																80				80		2.67			2.67			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H7993	2	0	1	1	1	H7993_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				773.57	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	1	0	1	4	1	H8003_001_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	1	0	1	4	1	H8003_001_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8003	1	0	1	4	1	H8003_001_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	45																			15	30	37.5																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	1	0	1	4	1	H8003_001_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	37	74	111																			37	74	92.5																37				37		1.23			1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	1	0	1	4	1	H8003_001_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				50.26	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	1	0	1	4	1	H8003_001_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	2	0	1	4	1	H8003_002_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	2	0	1	4	1	H8003_002_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8003	2	0	1	4	1	H8003_002_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	45																			15	30	37.5																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	2	0	1	4	1	H8003_002_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	37	74	111																			37	74	92.5																37				37		1.23			1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	2	0	1	4	1	H8003_002_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				53.64	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	2	0	1	4	1	H8003_002_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	3	0	1	4	1	H8003_003_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	3	0	1	4	1	H8003_003_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	0																			5	10	0																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8003	3	0	1	4	1	H8003_003_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	45																			15	30	37.5																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	3	0	1	4	1	H8003_003_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	37	74	111																			37	74	92.5																37				37		1.23			1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	3	0	1	4	1	H8003_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				51.92	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8003	3	0	1	4	1	H8003_003_0	6	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	2	0	1	1	1	H8010_002_0	7	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	2	0	1	1	1	H8010_002_0	7	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	2	0	1	1	1	H8010_002_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	2	0	1	1	1	H8010_002_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								95	190	285					85	170	255							170																95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	2	0	1	1	1	H8010_002_0	7	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2186.45	33	33	33				2186.45	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	3	0	1	1	1	H8010_003_0	7	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								12	24	36					0	0	0							0																12				12			0.4	0				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	3	0	1	1	1	H8010_003_0	7	Generic	4	11	1	1	2	1		111	1	100		1				30	60	100	1	2			100				30		31											9.91	25	25	25				9.91	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	3	0	1	1	1	H8010_003_0	7	Preferred Brand	4	11	1	1	3	1		111	1	100		1				30	60	100	1	2			100				30		31											169.44	25	25	25				169.44	22	22	22						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	3	0	1	1	1	H8010_003_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	100		1				30	60	100	1	2			100				30		31											216.56	25	25	25				216.56	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	3	0	1	1	1	H8010_003_0	7	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2062	25	25	25				2062	25	25	25						25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	5	0	1	1	1	H8010_005_0	7	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	5	0	1	1	1	H8010_005_0	7	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	5	0	1	1	1	H8010_005_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	5	0	1	1	1	H8010_005_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								95	190	285					85	170	255							170																95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	5	0	1	1	1	H8010_005_0	7	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2225.89	33	33	33				2225.89	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	8	0	1	1	1	H8010_008_0	7	Preferred Generic	4	11	1	2	1	1		111	1	100		1				30	60	100	1	2			100				30		31								5	10	15					0	0	0							0																5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	8	0	1	1	1	H8010_008_0	7	Generic	4	11	1	2	2	1		111	1	100		1				30	60	100	1	2			100				30		31								15	30	45					10	20	30							20																15				15			0.5	0.33				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	8	0	1	1	1	H8010_008_0	7	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	100	1	2			100				30		31								47	94	141					37	74	111							74																47				47			1.57	1.23				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	8	0	1	1	1	H8010_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	100		1				30	60	100	1	2			100				30		31								95	190	285					85	170	255							170																95				95			3.17	2.83				3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8010	8	0	1	1	1	H8010_008_0	7	Specialty Tier	4	11	1	1	5	1		111	1	100		1				30	60	100	1	2			100				30		31											2225.89	33	33	33				2225.89	33	33	33						33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8016	1	0	1	48	5	H8016_001_0	5	Generic Drugs	4	1			1	1	111		1			1	30	60	90				1	2							30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	3.6	0	3.6			0	3.6			
H8016	1	0	1	48	5	H8016_001_0	5	Brand Drugs	4	10			2	1	111		1			1	30	60	90				1	2							30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	8.95	0	8.95			0	8.95			
H8016	1	0	1	48	5	H8016_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1			1	30	60	90				1	2							30		31																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0			0	0			
H8026	1	0	1	48	5	H8026_001_0	4	Generic Drugs	4	11			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	0	0	0	0	0	0	0			
H8026	1	0	1	48	5	H8026_001_0	4	Brand Drugs	4	11			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	0	0	0	0	0	0	0			
H8026	1	0	1	48	5	H8026_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0			0	0			
H8046	1	0	1	48	5	H8046_001_0	5	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8046	1	0	1	48	5	H8046_001_0	5	Brand Drugs	4	11			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8046	1	0	1	48	5	H8046_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	10		1	10		1	31								31						31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8064	2	0	1	4	1	H8064_002_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	0	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	2	0	1	4	1	H8064_002_0	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	0	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H8064	2	0	1	4	1	H8064_002_0	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	18	36	54																			18	36	45																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	2	0	1	4	1	H8064_002_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	2	0	1	4	1	H8064_002_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	2	0	1	4	1	H8064_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				410	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	2	0	1	4	1	H8064_002_0	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	8	0																			8	8	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	2	0	1	4	1	H8064_002_0	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	8	0																			8	8	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H8064	4	0	1	4	1	H8064_004_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	0	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	4	0	1	4	1	H8064_004_0	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			8	0	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H8064	4	0	1	4	1	H8064_004_0	5	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	18	36	54																			18	36	45																18				18		0.6			0.6			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	4	0	1	4	1	H8064_004_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	45	90	135																			45	90	112.5																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	4	0	1	4	1	H8064_004_0	5	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	250																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	4	0	1	4	1	H8064_004_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				410	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	4	0	1	4	1	H8064_004_0	5	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	8	0																			8	8	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8064	4	0	1	4	1	H8064_004_0	5	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	8	0																			8	8	0																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H8087	1	0	1	4	1	H8087_001_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	1	0	1	4	1	H8087_001_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					8		24											20		60				8		0				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	1	0	1	4	1	H8087_001_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	1	0	1	4	1	H8087_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	1	0	1	4	1	H8087_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	2	0	1	4	1	H8087_002_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	2	0	1	4	1	H8087_002_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	2	0	1	4	1	H8087_002_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	2	0	1	4	1	H8087_002_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	2	0	1	4	1	H8087_002_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	3	0	1	4	1	H8087_003_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					0		0											10		30				0		0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	3	0	1	4	1	H8087_003_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	3	0	1	4	1	H8087_003_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	3	0	1	4	1	H8087_003_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8087	3	0	1	4	1	H8087_003_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8130	1	0	1	1	1	H8130_001_0	7	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8130	1	0	1	1	1	H8130_001_0	7	Preferred Generic	4	11	1	2	1	3	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8130	1	0	1	1	1	H8130_001_0	7	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8130	1	0	1	1	1	H8130_001_0	7	Generic	4	11	1	2	2	3	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8130	1	0	1	1	1	H8130_001_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	47	94	141																			47	94	141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8130	1	0	1	1	1	H8130_001_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				93.05	41	41	41																		41	41	41															41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8130	1	0	1	1	1	H8130_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				555.66	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8133	1	0	1	1	1	H8133_001_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	1	0	1	1	1	H8133_001_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8133	1	0	1	1	1	H8133_001_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	1	0	1	1	1	H8133_001_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	1	0	1	1	1	H8133_001_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	1	0	1	1	1	H8133_001_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	3	0	1	1	1	H8133_003_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	3	0	1	1	1	H8133_003_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8133	3	0	1	1	1	H8133_003_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	3	0	1	1	1	H8133_003_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	3	0	1	1	1	H8133_003_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	3	0	1	1	1	H8133_003_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												28		28					28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	5	0	1	1	1	H8133_005_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	5	0	1	1	1	H8133_005_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8133	5	0	1	1	1	H8133_005_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	5	0	1	1	1	H8133_005_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	5	0	1	1	1	H8133_005_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	5	0	1	1	1	H8133_005_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	7	0	1	1	1	H8133_007_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	7	0	1	1	1	H8133_007_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8133	7	0	1	1	1	H8133_007_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	7	0	1	1	1	H8133_007_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	7	0	1	1	1	H8133_007_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8133	7	0	1	1	1	H8133_007_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												27		27					27		27												27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8142	1	0	1	1	1	H8142_001_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	6	12	12																			6	12	12																6				6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	1	0	1	1	1	H8142_001_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	20	40	40																			20	40	40																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	1	0	1	1	1	H8142_001_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	47	94	94																			47	94	94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	1	0	1	1	1	H8142_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	100	200	200																			100	200	200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	1	0	1	1	1	H8142_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	2	0	1	1	1	H8142_002_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	6																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	2	0	1	1	1	H8142_002_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	15	30	30																			15	30	30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	2	0	1	1	1	H8142_002_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	90																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	2	0	1	1	1	H8142_002_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	190																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	2	0	1	1	1	H8142_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	3	0	1	1	1	H8142_003_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	2	4	4																			2	4	4																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	3	0	1	1	1	H8142_003_0	5	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	4	8	8																			4	8	8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8142	3	0	1	1	1	H8142_003_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	12	24	24																			12	24	24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	3	0	1	1	1	H8142_003_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	90																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	3	0	1	1	1	H8142_003_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	190																			95	190	190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8142	3	0	1	1	1	H8142_003_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	4	0	1	9	4	H8145_004_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	4	0	1	9	4	H8145_004_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	4	0	1	9	4	H8145_004_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	4	0	1	9	4	H8145_004_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	4	0	1	9	4	H8145_004_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												30							30												30						30					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	6	0	1	9	4	H8145_006_0	6	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	6	0	1	9	4	H8145_006_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	6	0	1	9	4	H8145_006_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	6	0	1	9	4	H8145_006_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	6	0	1	9	4	H8145_006_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	8	0	1	9	4	H8145_008_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	8	0	1	9	4	H8145_008_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	8	0	1	9	4	H8145_008_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	8	0	1	9	4	H8145_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	8	0	1	9	4	H8145_008_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	11	0	1	9	4	H8145_011_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	11	0	1	9	4	H8145_011_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	11	0	1	9	4	H8145_011_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	11	0	1	9	4	H8145_011_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	11	0	1	9	4	H8145_011_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	21	0	1	9	4	H8145_021_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	21	0	1	9	4	H8145_021_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	21	0	1	9	4	H8145_021_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	21	0	1	9	4	H8145_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	21	0	1	9	4	H8145_021_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	32	0	1	9	4	H8145_032_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	32	0	1	9	4	H8145_032_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	32	0	1	9	4	H8145_032_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	32	0	1	9	4	H8145_032_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	32	0	1	9	4	H8145_032_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	51	0	1	9	4	H8145_051_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	51	0	1	9	4	H8145_051_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	51	0	1	9	4	H8145_051_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	51	0	1	9	4	H8145_051_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	51	0	1	9	4	H8145_051_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	52	0	1	9	4	H8145_052_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	52	0	1	9	4	H8145_052_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	52	0	1	9	4	H8145_052_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	52	0	1	9	4	H8145_052_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	52	0	1	9	4	H8145_052_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	61	0	1	9	4	H8145_061_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	61	0	1	9	4	H8145_061_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	61	0	1	9	4	H8145_061_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	61	0	1	9	4	H8145_061_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					97		291											100		300				97		281				100				100			3.33	3.23		3.33	3.23	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	61	0	1	9	4	H8145_061_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	63	0	1	9	4	H8145_063_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	63	0	1	9	4	H8145_063_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	63	0	1	9	4	H8145_063_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	63	0	1	9	4	H8145_063_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	63	0	1	9	4	H8145_063_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	69	0	1	9	4	H8145_069_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	69	0	1	9	4	H8145_069_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	69	0	1	9	4	H8145_069_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	69	0	1	9	4	H8145_069_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	69	0	1	9	4	H8145_069_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	75	0	1	9	4	H8145_075_0	5	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					10		30											10		30				10		0				10				10			0.33	0.33		0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	75	0	1	9	4	H8145_075_0	5	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	75	0	1	9	4	H8145_075_0	5	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	75	0	1	9	4	H8145_075_0	5	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	75	0	1	9	4	H8145_075_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	84	0	1	9	4	H8145_084_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	84	0	1	9	4	H8145_084_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	84	0	1	9	4	H8145_084_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	84	0	1	9	4	H8145_084_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	84	0	1	9	4	H8145_084_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	87	0	1	9	4	H8145_087_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					8		24											11		33				8		0				11				11			0.37	0.27		0.37	0.27	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	87	0	1	9	4	H8145_087_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					16		48											20		60				16		0				20				20			0.67	0.53		0.67	0.53	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	87	0	1	9	4	H8145_087_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	87	0	1	9	4	H8145_087_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	87	0	1	9	4	H8145_087_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	89	0	1	9	4	H8145_089_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	89	0	1	9	4	H8145_089_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	89	0	1	9	4	H8145_089_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	89	0	1	9	4	H8145_089_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	89	0	1	9	4	H8145_089_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	91	0	1	9	4	H8145_091_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	91	0	1	9	4	H8145_091_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	91	0	1	9	4	H8145_091_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	91	0	1	9	4	H8145_091_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	91	0	1	9	4	H8145_091_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	122	0	1	9	4	H8145_122_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	122	0	1	9	4	H8145_122_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	122	0	1	9	4	H8145_122_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	122	0	1	9	4	H8145_122_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	122	0	1	9	4	H8145_122_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	123	0	1	9	4	H8145_123_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	123	0	1	9	4	H8145_123_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	123	0	1	9	4	H8145_123_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	123	0	1	9	4	H8145_123_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	123	0	1	9	4	H8145_123_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	125	0	1	9	4	H8145_125_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	125	0	1	9	4	H8145_125_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	125	0	1	9	4	H8145_125_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	125	0	1	9	4	H8145_125_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8145	125	0	1	9	4	H8145_125_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	1	0	1	1	1	H8170_001_0	7	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	1	0	1	1	1	H8170_001_0	7	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	45		135																			45		112.5																45				45		1.5			1.5			1.32	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	1	0	1	1	1	H8170_001_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	95		285																			95		237.5																95				95		3.17			3.17			2.79	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	1	0	1	1	1	H8170_001_0	7	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	2	0	1	1	1	H8170_002_0	7	Preferred Generic	4	11	3	2	1	1	110		1	110		1	30		90				2	2	30		90				30		34	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	2	0	1	1	1	H8170_002_0	7	Preferred Brand	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		34	45		135																			45		112.5																45				45		1.5			1.5			1.32	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	2	0	1	1	1	H8170_002_0	7	Non-Preferred Drug	4	11	3	2	3	1	110		1	110		1	30		90				2	2	30		90				30		34	95		285																			95		237.5																95				95		3.17			3.17			2.79	"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8170	2	0	1	1	1	H8170_002_0	7	Specialty Tier	4	11	1	1	4	1	10		1	10		1	30								30						30		34					33																				33																	33			33								"Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	1	0	1	1	1	H8176_001_0	6	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	1	0	1	1	1	H8176_001_0	6	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	4	8	12																			4	8	12																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	1	0	1	1	1	H8176_001_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	45	90	135																			45	90	135																45				45		1.45			1.45			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	1	0	1	1	1	H8176_001_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				108.73	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	1	0	1	1	1	H8176_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				491.54	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	2	0	1	1	1	H8176_002_0	7	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	2	0	1	1	1	H8176_002_0	7	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	4	8	12																			4	8	12																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	2	0	1	1	1	H8176_002_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	44	88	132																			44	88	132																44				44		1.42			1.42			1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	2	0	1	1	1	H8176_002_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				107.49	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8176	2	0	1	1	1	H8176_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				490.69	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8181	1	0	1	4	1	H8181_001_0	5	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					2	4	0																12				0			0.4	0	0.07			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8181	1	0	1	4	1	H8181_001_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					8	16	24					8	16	0																18				8			0.6	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8181	1	0	1	4	1	H8181_001_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	111																47				37			1.57	1.23	1.23			1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8181	1	0	1	4	1	H8181_001_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											62	45	45	45				62	45	45	45				45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8181	1	0	1	4	1	H8181_001_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	31						1	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8189	1	0	1	1	1	H8189_001_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8189	1	0	1	1	1	H8189_001_0	4	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8189	1	0	1	1	1	H8189_001_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8189	1	0	1	1	1	H8189_001_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8189	1	0	1	1	1	H8189_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8189	1	0	1	1	1	H8189_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8189	1	0	1	1	1	H8189_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8189	1	0	1	1	1	H8189_001_0	4	Select Care Drugs	4	11	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8197	1	0	1	48	5	H8197_001_0	10	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8197	1	0	1	48	5	H8197_001_0	10	Brand Drugs	4	11			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8197	1	0	1	48	5	H8197_001_0	10	Non-Medicare Rx/OTC Drugs	4	11			3	1	10		1	10		1	31								31						31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8211	1	0	1	4	1	H8211_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	1	0	1	4	1	H8211_001_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	1	0	1	4	1	H8211_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	1	0	1	4	1	H8211_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	1	0	1	4	1	H8211_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				629	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	2	0	1	4	1	H8211_002_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	2	0	1	4	1	H8211_002_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	2	0	1	4	1	H8211_002_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	2	0	1	4	1	H8211_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	2	0	1	4	1	H8211_002_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				865	31		31																										31						31			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	3	0	1	4	1	H8211_003_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	3	0	1	4	1	H8211_003_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	3	0	1	4	1	H8211_003_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	3	0	1	4	1	H8211_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	3	0	1	4	1	H8211_003_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				631	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	4	0	1	4	1	H8211_004_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	4	0	1	4	1	H8211_004_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	4	0	1	4	1	H8211_004_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	4	0	1	4	1	H8211_004_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8211	4	0	1	4	1	H8211_004_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				883	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8213	1	0	1	48	5	H8213_001_0	2	Generic Drugs	4	1			1	1	111		1	100		1	30	60	90				1	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8213	1	0	1	48	5	H8213_001_0	2	Brand Drugs	4	10			2	1	111		1	100		1	30	60	90				1	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8213	1	0	1	48	5	H8213_001_0	2	Non-Medicare Rx/OTC Drugs	4	10			3	1	111		1	100		1	30	60	90				1	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8225	1	0	1	1	1	H8225_001_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	4																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	1	0	1	1	1	H8225_001_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	1	0	1	1	1	H8225_001_0	3	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	1	0	1	1	1	H8225_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	1	0	1	1	1	H8225_001_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					26																																					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	1	0	1	1	1	H8225_001_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	2	0	1	1	1	H8225_002_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	2	4	4																					4																2				2		0.07						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	2	0	1	1	1	H8225_002_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	2	0	1	1	1	H8225_002_0	3	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	2	0	1	1	1	H8225_002_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	2	0	1	1	1	H8225_002_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	2	0	1	1	1	H8225_002_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	3	0	1	1	1	H8225_003_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	3	0	1	1	1	H8225_003_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	8	16	16																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	3	0	1	1	1	H8225_003_0	3	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	3	0	1	1	1	H8225_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	3	0	1	1	1	H8225_003_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					30																																					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	3	0	1	1	1	H8225_003_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	4	0	1	1	1	H8225_004_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	4	0	1	1	1	H8225_004_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	20																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	4	0	1	1	1	H8225_004_0	3	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	141																					141																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	4	0	1	1	1	H8225_004_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	100	200	300																					300																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	4	0	1	1	1	H8225_004_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8225	4	0	1	1	1	H8225_004_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8258	1	0	1	48	5	H8258_001_0	5	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8258	1	0	1	48	5	H8258_001_0	5	Brand Drugs	4	10			2	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	8.95			0	8.95	0	8.95			
H8258	1	0	1	48	5	H8258_001_0	5	Non-Medicare Rx Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8258	1	0	1	48	5	H8258_001_0	5	Non-Medicare OTC Drugs	4	11			4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8280	1	0	1	1	1	H8280_001_0	8	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	1	0	1	1	1	H8280_001_0	8	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					6		12					6		12																16				16			0.53	0.2	0.2			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	1	0	1	1	1	H8280_001_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	1	0	1	1	1	H8280_001_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	1	0	1	1	1	H8280_001_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											779.32	33						779.32	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	1	0	1	1	1	H8280_001_0	8	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	1	0	1	1	1	H8280_001_0	8	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8280	2	0	1	1	1	H8280_002_0	8	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	2	0	1	1	1	H8280_002_0	8	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	2	0	1	1	1	H8280_002_0	8	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	2	0	1	1	1	H8280_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	2	0	1	1	1	H8280_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											771	33						771	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	2	0	1	1	1	H8280_002_0	8	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8280	2	0	1	1	1	H8280_002_0	8	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8293	1	0	1	1	1	H8293_001_0	6	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	2		6																			2		6																2				2		0.07			0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8293	1	0	1	1	1	H8293_001_0	6	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	5		15																			5		15																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8293	1	0	1	1	1	H8293_001_0	6	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	42		126																			42		126																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8293	1	0	1	1	1	H8293_001_0	6	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8293	1	0	1	1	1	H8293_001_0	6	Specialty Tier	4	11	1	1	5	1	110		1	10		1	30		90				2	2	30						30		31				50	33		33																		33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8364	1	0	1	4	1	H8364_001_0	7	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	1	0	1	4	1	H8364_001_0	7	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	1	0	1	4	1	H8364_001_0	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	1	0	1	4	1	H8364_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	1	0	1	4	1	H8364_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											764.84	32						764.84	32						32																	32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	1	0	1	4	1	H8364_001_0	7	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	1	0	1	4	1	H8364_001_0	7	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8364	2	0	1	4	1	H8364_002_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	2	0	1	4	1	H8364_002_0	6	Generic	4	11	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								16		32					8		16					8		16																16				16			0.53	0.27	0.27			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	2	0	1	4	1	H8364_002_0	6	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					39		78					39		78																47				47			1.57	1.3	1.3			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	2	0	1	4	1	H8364_002_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		200					92		184					92		184																100				100			3.33	3.07	3.07			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	2	0	1	4	1	H8364_002_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											757.05	33						757.05	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	2	0	1	4	1	H8364_002_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	2	0	1	4	1	H8364_002_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8364	3	0	1	4	1	H8364_003_0	6	Preferred Generic	4	11	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								8		16					0		0					0		0																8				8			0.27	0	0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	3	0	1	4	1	H8364_003_0	6	Generic	4	11	1	1	2	1		110	1	110		1				30		90	1	2	30		90				30		31											10.74	25		25				10.74	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	3	0	1	4	1	H8364_003_0	6	Preferred Brand	4	11	1	1	3	1		110	1	110		1				30		90	1	2	30		90				30		31											60.88	25		25				60.88	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	3	0	1	4	1	H8364_003_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											76.96	25		25				76.96	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	3	0	1	4	1	H8364_003_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											675.83	25						675.83	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	3	0	1	4	1	H8364_003_0	6	Select Care Drugs	4	11	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8364	3	0	1	4	1	H8364_003_0	6	Select Care Drugs	4	11	1	2	6	3		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8423	1	0	1	48	5	H8423_001_0	6	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs"	3	0	0	0	0	0	0	0	0			
H8423	1	0	1	48	5	H8423_001_0	6	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs"	1	0	0	0	0	0	0	0	0			
H8432	2	0	1	1	1	H8432_002_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	2	0	1	1	1	H8432_002_0	5	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	2	0	1	1	1	H8432_002_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					7	14	21					7	21	21																7				7			0.23	0.23	0.23			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	2	0	1	1	1	H8432_002_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	2	0	1	1	1	H8432_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	2	0	1	1	1	H8432_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	2	0	1	1	1	H8432_002_0	5	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	2	0	1	1	1	H8432_002_0	5	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	5	0	1	2	1	H8432_005_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	5	0	1	2	1	H8432_005_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	5	0	1	2	1	H8432_005_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	5	0	1	2	1	H8432_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	5	0	1	2	1	H8432_005_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	5	0	1	2	1	H8432_005_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	5	0	1	2	1	H8432_005_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	6	0	1	2	1	H8432_006_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	6	0	1	2	1	H8432_006_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	6	0	1	2	1	H8432_006_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	6	0	1	2	1	H8432_006_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	6	0	1	2	1	H8432_006_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	6	0	1	2	1	H8432_006_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	6	0	1	2	1	H8432_006_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	7	0	1	1	1	H8432_007_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	7	0	1	1	1	H8432_007_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	7	0	1	1	1	H8432_007_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								6	12	18					6	12	18					6	18	18																6				6			0.2	0.2	0.2			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	7	0	1	1	1	H8432_007_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	7	0	1	1	1	H8432_007_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	7	0	1	1	1	H8432_007_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	7	0	1	1	1	H8432_007_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	7	0	1	1	1	H8432_007_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	8	5	1	1	1	H8432_008_5	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	5	1	1	1	H8432_008_5	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	5	1	1	1	H8432_008_5	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	5	1	1	1	H8432_008_5	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	5	1	1	1	H8432_008_5	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	6	1	1	1	H8432_008_6	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	6	1	1	1	H8432_008_6	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	6	1	1	1	H8432_008_6	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	6	1	1	1	H8432_008_6	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	6	1	1	1	H8432_008_6	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	7	1	1	1	H8432_008_7	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	7	1	1	1	H8432_008_7	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	7	1	1	1	H8432_008_7	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	7	1	1	1	H8432_008_7	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	8	7	1	1	1	H8432_008_7	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	9	0	1	1	1	H8432_009_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	9	0	1	1	1	H8432_009_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	9	0	1	1	1	H8432_009_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	9	0	1	1	1	H8432_009_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	9	0	1	1	1	H8432_009_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	10	0	1	1	1	H8432_010_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	10	0	1	1	1	H8432_010_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	10	0	1	1	1	H8432_010_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								45	90	135					40	80	120					40	120	120																45				45			1.5	1.33	1.33			1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	10	0	1	1	1	H8432_010_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	10	0	1	1	1	H8432_010_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	11	0	1	1	1	H8432_011_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	11	0	1	1	1	H8432_011_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	11	0	1	1	1	H8432_011_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	11	0	1	1	1	H8432_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	11	0	1	1	1	H8432_011_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	13	0	1	1	1	H8432_013_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	13	0	1	1	1	H8432_013_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	13	0	1	1	1	H8432_013_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	13	0	1	1	1	H8432_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	13	0	1	1	1	H8432_013_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	14	0	1	2	1	H8432_014_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	14	0	1	2	1	H8432_014_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	14	0	1	2	1	H8432_014_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	14	0	1	2	1	H8432_014_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	14	0	1	2	1	H8432_014_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	15	0	1	2	1	H8432_015_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	15	0	1	2	1	H8432_015_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	15	0	1	2	1	H8432_015_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	15	0	1	2	1	H8432_015_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								98	196	294					93	186	279					93	279	279																98				98			3.27	3.1	3.1			2.88	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	15	0	1	2	1	H8432_015_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	16	0	1	1	1	H8432_016_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	16	0	1	1	1	H8432_016_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	16	0	1	1	1	H8432_016_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	16	0	1	1	1	H8432_016_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	16	0	1	1	1	H8432_016_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	16	0	1	1	1	H8432_016_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	16	0	1	1	1	H8432_016_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	17	0	1	1	1	H8432_017_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	17	0	1	1	1	H8432_017_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	30	30																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	17	0	1	1	1	H8432_017_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	17	0	1	1	1	H8432_017_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	17	0	1	1	1	H8432_017_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8432	18	0	1	1	1	H8432_018_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	18	0	1	1	1	H8432_018_0	9	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	18	0	1	1	1	H8432_018_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								5	10	15					5	10	15					5	15	15																5				5			0.17	0.17	0.17			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	18	0	1	1	1	H8432_018_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	18	0	1	1	1	H8432_018_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	18	0	1	1	1	H8432_018_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	18	0	1	1	1	H8432_018_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	18	0	1	1	1	H8432_018_0	9	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	27	0	1	1	1	H8432_027_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	9	9																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	27	0	1	1	1	H8432_027_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	27	0	1	1	1	H8432_027_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	27	0	1	1	1	H8432_027_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	27	0	1	1	1	H8432_027_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	27	0	1	1	1	H8432_027_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	27	0	1	1	1	H8432_027_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	28	0	1	1	1	H8432_028_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	28	0	1	1	1	H8432_028_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H8432	28	0	1	1	1	H8432_028_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					7	14	21					7	21	21																7				7			0.23	0.23	0.23			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	28	0	1	1	1	H8432_028_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	28	0	1	1	1	H8432_028_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	28	0	1	1	1	H8432_028_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	28	0	1	1	1	H8432_028_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	28	0	1	1	1	H8432_028_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	31	1	1	1	1	H8432_031_1	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	1	1	1	1	H8432_031_1	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					7	14	21					7	21	21																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	1	1	1	1	H8432_031_1	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	1	1	1	1	H8432_031_1	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	1	1	1	1	H8432_031_1	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	1	1	1	1	H8432_031_1	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	1	1	1	1	H8432_031_1	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	31	2	1	1	1	H8432_031_2	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	2	1	1	1	H8432_031_2	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					7	14	21					7	21	21																12				12			0.4	0.23	0.23			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	2	1	1	1	H8432_031_2	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	2	1	1	1	H8432_031_2	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	2	1	1	1	H8432_031_2	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	2	1	1	1	H8432_031_2	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	31	2	1	1	1	H8432_031_2	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	32	0	1	1	1	H8432_032_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	9	9																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	32	0	1	1	1	H8432_032_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	32	0	1	1	1	H8432_032_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	32	0	1	1	1	H8432_032_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	32	0	1	1	1	H8432_032_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	32	0	1	1	1	H8432_032_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	32	0	1	1	1	H8432_032_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	33	0	1	1	1	H8432_033_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					3	6	9					3	9	9																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	33	0	1	1	1	H8432_033_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	45	45																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	33	0	1	1	1	H8432_033_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	33	0	1	1	1	H8432_033_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								99	198	297					94	188	282					94	282	282																99				99			3.3	3.13	3.13			2.91	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	33	0	1	1	1	H8432_033_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	33	0	1	1	1	H8432_033_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	33	0	1	1	1	H8432_033_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	34	0	1	1	1	H8432_034_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	34	0	1	1	1	H8432_034_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	34	0	1	1	1	H8432_034_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								6	12	18					6	12	18					6	18	18																6				6			0.2	0.2	0.2			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	34	0	1	1	1	H8432_034_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	34	0	1	1	1	H8432_034_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	34	0	1	1	1	H8432_034_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	34	0	1	1	1	H8432_034_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	34	0	1	1	1	H8432_034_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8432	35	0	1	1	1	H8432_035_0	10	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	35	0	1	1	1	H8432_035_0	10	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H8432	35	0	1	1	1	H8432_035_0	10	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					15	30	45					15	45	45																15				15			0.5	0.5	0.5			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	35	0	1	1	1	H8432_035_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	35	0	1	1	1	H8432_035_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	35	0	1	1	1	H8432_035_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	35	0	1	1	1	H8432_035_0	10	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8432	35	0	1	1	1	H8432_035_0	10	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8452	1	0	1	48	5	H8452_001_0	5	Generic Drugs	4	11			1	1	111		1	100		1	30	60	90				2	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8452	1	0	1	48	5	H8452_001_0	5	Brand Drugs	4	11			2	1	111		1	100		1	30	60	90				2	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8452	1	0	1	48	5	H8452_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	100		1	30	60	90				1	2			90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8552	20	0	1	4	1	H8552_020_0	11	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	20	0	1	4	1	H8552_020_0	11	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					8	16	24					8	24	24																13				13			0.43	0.27	0.27			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	20	0	1	4	1	H8552_020_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	20	0	1	4	1	H8552_020_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	20	0	1	4	1	H8552_020_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	20	0	1	4	1	H8552_020_0	11	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	28	0	1	4	1	H8552_028_0	15	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								6	12	18					1	2	3					1	3	3																6				6			0.2	0.03	0.03			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	28	0	1	4	1	H8552_028_0	15	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								11	22	33					6	12	18					6	18	18																11				11			0.37	0.2	0.2			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	28	0	1	4	1	H8552_028_0	15	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	28	0	1	4	1	H8552_028_0	15	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	28	0	1	4	1	H8552_028_0	15	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	28	0	1	4	1	H8552_028_0	15	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	28	0	1	4	1	H8552_028_0	15	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8552	29	0	1	4	1	H8552_029_0	9	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	12	12																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	29	0	1	4	1	H8552_029_0	9	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					12	24	36					12	36	36																17				17			0.57	0.4	0.4			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	29	0	1	4	1	H8552_029_0	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	126	126																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	29	0	1	4	1	H8552_029_0	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	29	0	1	4	1	H8552_029_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												26							26						26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	29	0	1	4	1	H8552_029_0	9	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	30	0	1	4	1	H8552_030_0	12	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	30	0	1	4	1	H8552_030_0	12	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8552	30	0	1	4	1	H8552_030_0	12	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	12	12																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	30	0	1	4	1	H8552_030_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								36	72	108					36	72	108					36	108	108																36				36			1.2	1.2	1.2			1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	30	0	1	4	1	H8552_030_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	30	0	1	4	1	H8552_030_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	30	0	1	4	1	H8552_030_0	12	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H8552	30	0	1	4	1	H8552_030_0	12	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H8554	1	0	1	1	1	H8554_001_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8554	1	0	1	1	1	H8554_001_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8554	1	0	1	1	1	H8554_001_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8554	1	0	1	1	1	H8554_001_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8554	1	0	1	1	1	H8554_001_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8554	1	0	1	1	1	H8554_001_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												28		28					28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8578	1	0	1	1	1	H8578_001_0	6	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	1	0	1	1	1	H8578_001_0	6	Preferred Generic	4	11	1	2	1	3	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8578	1	0	1	1	1	H8578_001_0	6	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	1	0	1	1	1	H8578_001_0	6	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	1	0	1	1	1	H8578_001_0	6	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	95	190	285																					285																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	1	0	1	1	1	H8578_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	4	0	1	1	1	H8578_004_0	6	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	4	0	1	1	1	H8578_004_0	6	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	4	0	1	1	1	H8578_004_0	6	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	4	0	1	1	1	H8578_004_0	6	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	95	190	285																					285																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	4	0	1	1	1	H8578_004_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	12	0	1	1	1	H8578_012_0	7	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	12	0	1	1	1	H8578_012_0	7	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	12	0	1	1	1	H8578_012_0	7	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	12	0	1	1	1	H8578_012_0	7	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	95	190	285																					285																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	12	0	1	1	1	H8578_012_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1	26																																					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	16	0	1	2	1	H8578_016_0	6	Preferred Generic	4	11	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	4	8	12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	16	0	1	2	1	H8578_016_0	6	Generic	4	11	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	10	20	30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	16	0	1	2	1	H8578_016_0	6	Preferred Brand	4	11	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	16	0	1	2	1	H8578_016_0	6	Non-Preferred Drug	4	11	3	2	4	1	111		1	100		1	30	60	90				1	2			90				30		31	95	190	285																					285																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8578	16	0	1	2	1	H8578_016_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				1	28																																					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8597	1	0	1	1	1	H8597_001_0	3	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	1	0	1	1	1	H8597_001_0	3	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	1	0	1	1	1	H8597_001_0	3	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	1	0	1	1	1	H8597_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	1	0	1	1	1	H8597_001_0	3	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				603.77	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	2	0	1	1	1	H8597_002_0	2	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	2	0	1	1	1	H8597_002_0	2	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	2	0	1	1	1	H8597_002_0	2	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	2	0	1	1	1	H8597_002_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	2	0	1	1	1	H8597_002_0	2	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				603.77	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	3	0	1	1	1	H8597_003_0	2	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	3	0	1	1	1	H8597_003_0	2	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	3	0	1	1	1	H8597_003_0	2	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	3	0	1	1	1	H8597_003_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8597	3	0	1	1	1	H8597_003_0	2	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				603.77	28																				28																		28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8604	10	0	1	4	1	H8604_010_0	8	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								13		39					3		9							0																13				13			0.43	0.1				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	10	0	1	4	1	H8604_010_0	8	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	10	0	1	4	1	H8604_010_0	8	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	10	0	1	4	1	H8604_010_0	8	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	10	0	1	4	1	H8604_010_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	31						1000	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	11	0	1	4	1	H8604_011_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								13		39					3		9							0																13				13			0.43	0.1				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	11	0	1	4	1	H8604_011_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	11	0	1	4	1	H8604_011_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	11	0	1	4	1	H8604_011_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	11	0	1	4	1	H8604_011_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	31						1000	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	13	0	1	4	1	H8604_013_0	7	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	1			90				30		31								13		39					3		9							0																13				13			0.43	0.1				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	13	0	1	4	1	H8604_013_0	7	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	1			90				30		31								20		60					10		30							0																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	13	0	1	4	1	H8604_013_0	7	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	1			90				30		31								47		141					47		141							94																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	13	0	1	4	1	H8604_013_0	7	Non-Preferred Drug	4	11	1	2	4	1		110	1	100		1				30		90	1	1			90				30		31								100		300					100		300							200																100				100			3.33	3.33				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8604	13	0	1	4	1	H8604_013_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1000	31						1000	31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8634	2	0	1	4	1	H8634_002_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	2	0	1	4	1	H8634_002_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8634	2	0	1	4	1	H8634_002_0	4	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	2	0	1	4	1	H8634_002_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	2	0	1	4	1	H8634_002_0	4	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	2	0	1	4	1	H8634_002_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	3	0	1	4	1	H8634_003_0	4	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					3		0													24						0				8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	3	0	1	4	1	H8634_003_0	4	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								8		24					3		0													24						0				8				8			0.27	0.1				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8634	3	0	1	4	1	H8634_003_0	4	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	3	0	1	4	1	H8634_003_0	4	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	3	0	1	4	1	H8634_003_0	4	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	3	0	1	4	1	H8634_003_0	4	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	4	0	1	4	1	H8634_004_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	4	0	1	4	1	H8634_004_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H8634	4	0	1	4	1	H8634_004_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					14		42													57						42				19				19			0.63	0.47				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	4	0	1	4	1	H8634_004_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	4	0	1	4	1	H8634_004_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8634	4	0	1	4	1	H8634_004_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8649	3	0	1	1	1	H8649_003_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	3	0	1	1	1	H8649_003_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8649	3	0	1	1	1	H8649_003_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	3	0	1	1	1	H8649_003_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8649	3	0	1	1	1	H8649_003_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	3	0	1	1	1	H8649_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	3	0	1	1	1	H8649_003_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											903.6	31						930.08	31												31						31						31		31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	8	0	1	1	1	H8649_008_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	8	0	1	1	1	H8649_008_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3	6	0																			3	6	0																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8649	8	0	1	1	1	H8649_008_0	5	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	10	20	0																			10	20	0																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	8	0	1	1	1	H8649_008_0	5	Generic	4	1	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	10	20	0																			10	20	0																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H8649	8	0	1	1	1	H8649_008_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47	94	141																			47	94	141																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	8	0	1	1	1	H8649_008_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8649	8	0	1	1	1	H8649_008_0	5	Specialty Tier	4	11	1	1	5	1	10		10	10		1	30								30							10	31				749.27	29																				29																		29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H8677	1	0	1	48	5	H8677_001_0	5	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8677	1	0	1	48	5	H8677_001_0	5	Brand Drugs	4	11			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8677	1	0	1	48	5	H8677_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	10		1	10		1	31								31						31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8677	2	0	1	48	5	H8677_002_0	5	Generic Drugs	4	1			1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8677	2	0	1	48	5	H8677_002_0	5	Brand Drugs	4	11			2	1	111		1	111		1	31	60	90				2	2	31	60	90				31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8677	2	0	1	48	5	H8677_002_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	10		1	10		1	31								31						31		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H8748	2	0	1	2	1	H8748_002_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	2	0	1	2	1	H8748_002_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	2	0	1	2	1	H8748_002_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	2	0	1	2	1	H8748_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	2	0	1	2	1	H8748_002_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				979	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	8	0	1	2	1	H8748_008_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		8																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	8	0	1	2	1	H8748_008_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	8	0	1	2	1	H8748_008_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	8	0	1	2	1	H8748_008_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	8	0	1	2	1	H8748_008_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				815	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	9	0	1	2	1	H8748_009_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	9	0	1	2	1	H8748_009_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		20																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	9	0	1	2	1	H8748_009_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	9	0	1	2	1	H8748_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	9	0	1	2	1	H8748_009_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				892	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	25	0	1	2	1	H8748_025_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		4																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	25	0	1	2	1	H8748_025_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		16																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	25	0	1	2	1	H8748_025_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	25	0	1	2	1	H8748_025_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8748	25	0	1	2	1	H8748_025_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				1010	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8764	1	0	1	1	1	H8764_001_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	4		12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	1	0	1	1	1	H8764_001_0	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	4		12																					8																4				4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H8764	1	0	1	1	1	H8764_001_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	8		24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	1	0	1	1	1	H8764_001_0	7	Generic	4	1	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	8		24																					16																8				8		0.27						0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H8764	1	0	1	1	1	H8764_001_0	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	45		135																					90																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	1	0	1	1	1	H8764_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	95		285																					190																95				95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	1	0	1	1	1	H8764_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					30																																					30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	1	0	1	1	1	H8764_001_0	7	Select Diabetic Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	11		33																					22																11				11		0.37						0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	2	0	1	2	1	H8764_002_0	7	Preferred Generic	4	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	2	0	1	2	1	H8764_002_0	7	Preferred Generic	4	1	1	2	1	3	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H8764	2	0	1	2	1	H8764_002_0	7	Generic	4	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	2	0	1	2	1	H8764_002_0	7	Generic	4	1	1	2	2	3	110		1	100		1	30		90				1	2			90				30		31	10		30																					20																10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"										1		
H8764	2	0	1	2	1	H8764_002_0	7	Preferred Brand	4	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	42		126																					84																42				42		1.4						1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	2	0	1	2	1	H8764_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	90		270																					180																90				90		3						2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	2	0	1	2	1	H8764_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	2	0	1	2	1	H8764_002_0	7	Select Diabetic Drugs	4	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	0		0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	3	0	1	1	1	H8764_003_0	7	Preferred Generic	3	1	1	2	1	1	110		1	100		1	30		90				1	2			90				30		31	7		21																					14																7				7		0.23						0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	3	0	1	1	1	H8764_003_0	7	Generic	3	1	1	2	2	1	110		1	100		1	30		90				1	2			90				30		31	14		42																					28																14				14		0.47						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	3	0	1	1	1	H8764_003_0	7	Preferred Brand	3	10	1	2	3	1	110		1	100		1	30		90				1	2			90				30		31	47		141																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	3	0	1	1	1	H8764_003_0	7	Non-Preferred Drug	3	11	1	2	4	1	110		1	100		1	30		90				1	2			90				30		31	100		300																					200																100				100		3.33						3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	3	0	1	1	1	H8764_003_0	7	Specialty Tier	3	11	1	1	5	1	10		1			1	30														30		31				965.12	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8764	3	0	1	1	1	H8764_003_0	7	Select Diabetic Drugs	3	11	1	2	6	1	110		1	100		1	30		90				1	2			90				30		31	11		33																					22																11				11		0.37						0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs"												
H8768	3	0	1	4	1	H8768_003_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	3	0	1	4	1	H8768_003_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	3	0	1	4	1	H8768_003_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	3	0	1	4	1	H8768_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	3	0	1	4	1	H8768_003_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				955	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	5	0	1	4	1	H8768_005_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	5	0	1	4	1	H8768_005_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	5	0	1	4	1	H8768_005_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	5	0	1	4	1	H8768_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	5	0	1	4	1	H8768_005_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				951	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	6	0	1	4	1	H8768_006_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	6	0	1	4	1	H8768_006_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	6	0	1	4	1	H8768_006_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	6	0	1	4	1	H8768_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	6	0	1	4	1	H8768_006_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				886	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	7	0	1	4	1	H8768_007_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	7	0	1	4	1	H8768_007_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	8		24																											24						0				8				8		0.26						0.25	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	7	0	1	4	1	H8768_007_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	45		135																											135						125				45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	7	0	1	4	1	H8768_007_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	7	0	1	4	1	H8768_007_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				746	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	8	0	1	4	1	H8768_008_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	8	0	1	4	1	H8768_008_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	8	0	1	4	1	H8768_008_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	8	0	1	4	1	H8768_008_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	8	0	1	4	1	H8768_008_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				960	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	9	0	1	4	1	H8768_009_0	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	9	0	1	4	1	H8768_009_0	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	9	0	1	4	1	H8768_009_0	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	9	0	1	4	1	H8768_009_0	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	95		285																											285						275				95				95		3.16						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	9	0	1	4	1	H8768_009_0	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				809	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	10	0	1	4	1	H8768_010_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	10	0	1	4	1	H8768_010_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	10	0	1	4	1	H8768_010_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	10	0	1	4	1	H8768_010_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	10	0	1	4	1	H8768_010_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											936	28		28				781	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	11	0	1	4	1	H8768_011_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	11	0	1	4	1	H8768_011_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	11	0	1	4	1	H8768_011_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	11	0	1	4	1	H8768_011_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	11	0	1	4	1	H8768_011_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											948	28		28				797	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	12	0	1	4	1	H8768_012_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	12	0	1	4	1	H8768_012_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	12	0	1	4	1	H8768_012_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	12	0	1	4	1	H8768_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	12	0	1	4	1	H8768_012_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				688	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	13	0	1	4	1	H8768_013_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	2		6																											6						0				2				2		0.06						0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	13	0	1	4	1	H8768_013_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	13	0	1	4	1	H8768_013_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	13	0	1	4	1	H8768_013_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	13	0	1	4	1	H8768_013_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				688	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	14	0	1	4	1	H8768_014_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	14	0	1	4	1	H8768_014_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	14	0	1	4	1	H8768_014_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	14	0	1	4	1	H8768_014_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	14	0	1	4	1	H8768_014_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											910	29		29				702	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	15	0	1	4	1	H8768_015_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	15	0	1	4	1	H8768_015_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	15	0	1	4	1	H8768_015_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	15	0	1	4	1	H8768_015_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	15	0	1	4	1	H8768_015_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											668	28		28				607	28		28												28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	16	0	1	4	1	H8768_016_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								10		30					0		0													30						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	16	0	1	4	1	H8768_016_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		10													60						10				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	16	0	1	4	1	H8768_016_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					47		131													141						131				47				47			1.56	1.56				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	16	0	1	4	1	H8768_016_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		100	1				30		90	2	2						90	30		31								100		300					100		290													300						290				100				100			3.33	3.33				3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	16	0	1	4	1	H8768_016_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											898	29		29				644	29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	1	1	4	1	H8768_017_1	2	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	1	1	4	1	H8768_017_1	2	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	1	1	4	1	H8768_017_1	2	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	1	1	4	1	H8768_017_1	2	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	1	1	4	1	H8768_017_1	2	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				798	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	2	1	4	1	H8768_017_2	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	2	1	4	1	H8768_017_2	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	10		30																											30						0				10				10		0.33						0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	2	1	4	1	H8768_017_2	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	2	1	4	1	H8768_017_2	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8768	17	2	1	4	1	H8768_017_2	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				798	33		33																										33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	1	0	1	4	1	H8783_001_0	7	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10		30					1		3											10		20				1		2					10			10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	1	0	1	4	1	H8783_001_0	7	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20		60					10		30											20		40				10		20					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	1	0	1	4	1	H8783_001_0	7	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47		141					40		120											47		94				40		80					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	1	0	1	4	1	H8783_001_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											46	50		50				41	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	1	0	1	4	1	H8783_001_0	7	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1331	25		25				1331	25		25										25		25				25		25				25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	2	0	1	4	1	H8783_002_0	6	Preferred Generic	4	1	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10		30					1		3											10		20				1		2					10			10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	2	0	1	4	1	H8783_002_0	6	Generic	4	1	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17		51					7		21											17		34				7		14					17			17			0.57	0.23		0.57	0.23	0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	2	0	1	4	1	H8783_002_0	6	Preferred Brand	4	10	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45		135					35		105											45		90				35		70					45			45			1.5	1.17		1.5	1.17	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	2	0	1	4	1	H8783_002_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											49	50		50				44	45		45										50		50				45		45				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8783	2	0	1	4	1	H8783_002_0	6	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1723	28		28				1723	28		28										28		28				28		28				28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8786	1	0	1	48	5	H8786_001_0	6	Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																														0			0			0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	0	0	0	0	0	0	0			
H8786	1	0	1	48	5	H8786_001_0	6	Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	1	0	8.95			0	8.95	0	8.95			
H8786	1	0	1	48	5	H8786_001_0	6	Non-Medicare Rx Drugs	4	11			3	1	10		10			1	31															10	34																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0			0	0			
H8786	1	0	1	48	5	H8786_001_0	6	Non-Medicare OTC Drugs	4	11			4	1	10		10			1	31															10	34																																														0						0	"Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs"	2	0	0	0	0			0	0			
H8889	1	0	1	4	1	H8889_001_0	10	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	1	0	1	4	1	H8889_001_0	10	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								18		54					9		27							17																18				18			0.6	0.3				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	1	0	1	4	1	H8889_001_0	10	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		141							131																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	1	0	1	4	1	H8889_001_0	10	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											101.16	50		50				108.46	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	1	0	1	4	1	H8889_001_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	2	0	1	4	1	H8889_002_0	10	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								10		30					0		0							0																10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	2	0	1	4	1	H8889_002_0	10	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					10		30							20																20				20			0.67	0.33				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	2	0	1	4	1	H8889_002_0	10	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		141							131																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	2	0	1	4	1	H8889_002_0	10	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											88.5	50		50				92.76	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	2	0	1	4	1	H8889_002_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												27							27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	3	0	1	4	1	H8889_003_0	10	Preferred Generic	4	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								8		24					0		0							0																8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	3	0	1	4	1	H8889_003_0	10	Generic	4	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								18		54					9		27							17																18				18			0.6	0.3				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	3	0	1	4	1	H8889_003_0	10	Preferred Brand	4	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					47		141							131																47				47			1.57	1.57				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	3	0	1	4	1	H8889_003_0	10	Non-Preferred Drug	4	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											61.85	50		50				70.81	50		50						50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	3	0	1	4	1	H8889_003_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	4	0	1	4	1	H8889_004_0	10	Preferred Generic	3	1	1	2	1	1		110	1	100		1				30		90	1	2			90				30		31								15		45					8		24							0																15				15			0.5	0.27				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	4	0	1	4	1	H8889_004_0	10	Generic	3	1	1	2	2	1		110	1	100		1				30		90	1	2			90				30		31								20		60					12		36							26																20				20			0.67	0.4				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	4	0	1	4	1	H8889_004_0	10	Preferred Brand	3	10	1	2	3	1		110	1	100		1				30		90	1	2			90				30		31								47		141					45		135							125																47				47			1.57	1.5				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	4	0	1	4	1	H8889_004_0	10	Non-Preferred Drug	3	11	1	1	4	1		110	1	100		1				30		90	1	2			90				30		31											81.83	50		50				85.83	45		45						45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8889	4	0	1	4	1	H8889_004_0	10	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	1	0	1	1	1	H8908_001_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	1	0	1	1	1	H8908_001_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	1	0	1	1	1	H8908_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	1	0	1	1	1	H8908_001_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	1	0	1	1	1	H8908_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	2	0	1	1	1	H8908_002_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	2	0	1	1	1	H8908_002_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	2	0	1	1	1	H8908_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	2	0	1	1	1	H8908_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	2	0	1	1	1	H8908_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	4	0	1	1	1	H8908_004_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	4	0	1	1	1	H8908_004_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	4	0	1	1	1	H8908_004_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	4	0	1	1	1	H8908_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	4	0	1	1	1	H8908_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	5	0	1	1	1	H8908_005_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								0		0					0		0											0		0				0		0				0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	5	0	1	1	1	H8908_005_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					11		33											20		60				11		0				20				20			0.67	0.37		0.67	0.37	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	5	0	1	1	1	H8908_005_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	5	0	1	1	1	H8908_005_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8908	5	0	1	1	1	H8908_005_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H8916	1	0	1	1	1	H8916_001_0	10	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	9																			3	6	9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8916	1	0	1	1	1	H8916_001_0	10	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	9																			3	6	9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H8916	1	0	1	1	1	H8916_001_0	10	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	30																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8916	1	0	1	1	1	H8916_001_0	10	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	135																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8916	1	0	1	1	1	H8916_001_0	10	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	95	190	285																			95	190	285																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8916	1	0	1	1	1	H8916_001_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8916	1	0	1	1	1	H8916_001_0	10	Select Care Drugs	4	1	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H8916	1	0	1	1	1	H8916_001_0	10	Select Care Drugs	4	1	1	2	6	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"										1		
H8967	2	0	1	1	1	H8967_002_0	7	Preferred Generic	4	1	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4	8	12																																						4			4		0.13						0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8967	2	0	1	1	1	H8967_002_0	7	Generic	4	1	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15	30	45																																						15			15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8967	2	0	1	1	1	H8967_002_0	7	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45	90	135																																						45			45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8967	2	0	1	1	1	H8967_002_0	7	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95	190	285																																						95			95		3.17						3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H8967	2	0	1	1	1	H8967_002_0	7	Specialty Tier	4	11	1	1	5	1	10		10			1	30															10	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9001	30	4	1	1	1	H9001_030_4	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	4	1	1	1	H9001_030_4	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	4	1	1	1	H9001_030_4	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	4	1	1	1	H9001_030_4	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	4	1	1	1	H9001_030_4	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	4	1	1	1	H9001_030_4	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	5	1	1	1	H9001_030_5	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	5	1	1	1	H9001_030_5	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	5	1	1	1	H9001_030_5	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	5	1	1	1	H9001_030_5	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	5	1	1	1	H9001_030_5	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	5	1	1	1	H9001_030_5	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	7	1	1	1	H9001_030_7	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	7	1	1	1	H9001_030_7	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	7	1	1	1	H9001_030_7	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	7	1	1	1	H9001_030_7	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	7	1	1	1	H9001_030_7	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	7	1	1	1	H9001_030_7	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	8	1	1	1	H9001_030_8	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	8	1	1	1	H9001_030_8	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	8	1	1	1	H9001_030_8	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	8	1	1	1	H9001_030_8	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	8	1	1	1	H9001_030_8	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	8	1	1	1	H9001_030_8	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	9	1	1	1	H9001_030_9	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	9	1	1	1	H9001_030_9	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	9	1	1	1	H9001_030_9	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	9	1	1	1	H9001_030_9	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	9	1	1	1	H9001_030_9	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	9	1	1	1	H9001_030_9	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	11	1	1	1	H9001_030_11	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	11	1	1	1	H9001_030_11	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	11	1	1	1	H9001_030_11	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	11	1	1	1	H9001_030_11	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	11	1	1	1	H9001_030_11	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	30	11	1	1	1	H9001_030_11	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	4	1	1	1	H9001_031_4	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	4	1	1	1	H9001_031_4	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	4	1	1	1	H9001_031_4	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	4	1	1	1	H9001_031_4	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	4	1	1	1	H9001_031_4	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	4	1	1	1	H9001_031_4	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	6	1	1	1	H9001_031_6	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	6	1	1	1	H9001_031_6	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	6	1	1	1	H9001_031_6	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	6	1	1	1	H9001_031_6	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	6	1	1	1	H9001_031_6	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	6	1	1	1	H9001_031_6	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	7	1	1	1	H9001_031_7	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	7	1	1	1	H9001_031_7	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	7	1	1	1	H9001_031_7	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	7	1	1	1	H9001_031_7	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	7	1	1	1	H9001_031_7	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	7	1	1	1	H9001_031_7	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	8	1	1	1	H9001_031_8	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	8	1	1	1	H9001_031_8	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	8	1	1	1	H9001_031_8	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	8	1	1	1	H9001_031_8	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	8	1	1	1	H9001_031_8	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	8	1	1	1	H9001_031_8	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	9	1	1	1	H9001_031_9	9	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	9	1	1	1	H9001_031_9	9	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	9	1	1	1	H9001_031_9	9	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	9	1	1	1	H9001_031_9	9	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	9	1	1	1	H9001_031_9	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	9	1	1	1	H9001_031_9	9	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	10	1	1	1	H9001_031_10	9	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	10	1	1	1	H9001_031_10	9	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	10	1	1	1	H9001_031_10	9	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	10	1	1	1	H9001_031_10	9	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	10	1	1	1	H9001_031_10	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	31	10	1	1	1	H9001_031_10	9	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	4	1	1	1	H9001_032_4	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	14				2	4	4				2				2			0.23	0.07		0.23	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	4	1	1	1	H9001_032_4	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					9	18	27											14	28	28				9	18	18				9				9			0.47	0.3		0.47	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	4	1	1	1	H9001_032_4	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					42	84	126											47	94	94				42	84	84				42				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	4	1	1	1	H9001_032_4	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					95	190	285											100	200	200				95	190	190				95				95			3.33	3.17		3.33	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	4	1	1	1	H9001_032_4	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	4	1	1	1	H9001_032_4	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	5	1	1	1	H9001_032_5	9	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	14				2	4	4				2				2			0.23	0.07		0.23	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	5	1	1	1	H9001_032_5	9	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					9	18	27											14	28	28				9	18	18				9				9			0.47	0.3		0.47	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	5	1	1	1	H9001_032_5	9	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					42	84	126											47	94	94				42	84	84				42				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	5	1	1	1	H9001_032_5	9	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					95	190	285											100	200	200				95	190	190				95				95			3.33	3.17		3.33	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	5	1	1	1	H9001_032_5	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	5	1	1	1	H9001_032_5	9	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	6	1	1	1	H9001_032_6	9	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	14				2	4	4				2				2			0.23	0.07		0.23	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	6	1	1	1	H9001_032_6	9	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					9	18	27											14	28	28				9	18	18				9				9			0.47	0.3		0.47	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	6	1	1	1	H9001_032_6	9	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					42	84	126											47	94	94				42	84	84				42				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	6	1	1	1	H9001_032_6	9	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					95	190	285											100	200	200				95	190	190				95				95			3.33	3.17		3.33	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	6	1	1	1	H9001_032_6	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	6	1	1	1	H9001_032_6	9	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	7	1	1	1	H9001_032_7	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	14				2	4	4				2				2			0.23	0.07		0.23	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	7	1	1	1	H9001_032_7	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					9	18	27											14	28	28				9	18	18				9				9			0.47	0.3		0.47	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	7	1	1	1	H9001_032_7	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					42	84	126											47	94	94				42	84	84				42				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	7	1	1	1	H9001_032_7	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					95	190	285											100	200	200				95	190	190				95				95			3.33	3.17		3.33	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	7	1	1	1	H9001_032_7	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	7	1	1	1	H9001_032_7	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	8	1	1	1	H9001_032_8	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	14				2	4	4				2				2			0.23	0.07		0.23	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	8	1	1	1	H9001_032_8	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					9	18	27											14	28	28				9	18	18				9				9			0.47	0.3		0.47	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	8	1	1	1	H9001_032_8	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					42	84	126											47	94	94				42	84	84				42				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	8	1	1	1	H9001_032_8	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					95	190	285											100	200	200				95	190	190				95				95			3.33	3.17		3.33	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	8	1	1	1	H9001_032_8	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	8	1	1	1	H9001_032_8	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	9	1	1	1	H9001_032_9	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	21					2	4	6											7	14	14				2	4	4				2				2			0.23	0.07		0.23	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	9	1	1	1	H9001_032_9	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								14	28	42					9	18	27											14	28	28				9	18	18				9				9			0.47	0.3		0.47	0.3	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	9	1	1	1	H9001_032_9	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					42	84	126											47	94	94				42	84	84				42				42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	9	1	1	1	H9001_032_9	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								100	200	300					95	190	285											100	200	200				95	190	190				95				95			3.33	3.17		3.33	3.17	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	9	1	1	1	H9001_032_9	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	32	9	1	1	1	H9001_032_9	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	5	1	1	1	H9001_034_5	10	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	5	1	1	1	H9001_034_5	10	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	5	1	1	1	H9001_034_5	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	5	1	1	1	H9001_034_5	10	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	5	1	1	1	H9001_034_5	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	5	1	1	1	H9001_034_5	10	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	6	1	1	1	H9001_034_6	10	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	6	1	1	1	H9001_034_6	10	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	6	1	1	1	H9001_034_6	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	6	1	1	1	H9001_034_6	10	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	6	1	1	1	H9001_034_6	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	6	1	1	1	H9001_034_6	10	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	8	1	1	1	H9001_034_8	10	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	8	1	1	1	H9001_034_8	10	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	8	1	1	1	H9001_034_8	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	8	1	1	1	H9001_034_8	10	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	8	1	1	1	H9001_034_8	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	8	1	1	1	H9001_034_8	10	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	9	1	1	1	H9001_034_9	10	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	9	1	1	1	H9001_034_9	10	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	9	1	1	1	H9001_034_9	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	9	1	1	1	H9001_034_9	10	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	9	1	1	1	H9001_034_9	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	9	1	1	1	H9001_034_9	10	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	12	1	1	1	H9001_034_12	10	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	12	1	1	1	H9001_034_12	10	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	12	1	1	1	H9001_034_12	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	12	1	1	1	H9001_034_12	10	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	12	1	1	1	H9001_034_12	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	12	1	1	1	H9001_034_12	10	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	13	1	1	1	H9001_034_13	10	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	13	1	1	1	H9001_034_13	10	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	13	1	1	1	H9001_034_13	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	13	1	1	1	H9001_034_13	10	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	13	1	1	1	H9001_034_13	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	34	13	1	1	1	H9001_034_13	10	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	35	0	1	1	1	H9001_035_0	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	35	0	1	1	1	H9001_035_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	35	0	1	1	1	H9001_035_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	35	0	1	1	1	H9001_035_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	35	0	1	1	1	H9001_035_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	35	0	1	1	1	H9001_035_0	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	36	0	1	1	1	H9001_036_0	8	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	36	0	1	1	1	H9001_036_0	8	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	36	0	1	1	1	H9001_036_0	8	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	36	0	1	1	1	H9001_036_0	8	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	36	0	1	1	1	H9001_036_0	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	36	0	1	1	1	H9001_036_0	8	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	37	0	1	1	1	H9001_037_0	10	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	12				1	2	2				1				1			0.2	0.03		0.2	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	37	0	1	1	1	H9001_037_0	10	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								12	24	36					7	14	21											12	24	24				7	14	14				7				7			0.4	0.23		0.4	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	37	0	1	1	1	H9001_037_0	10	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								42	84	126					37	74	111											42	84	84				37	74	74				37				37			1.4	1.23		1.4	1.23	1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	37	0	1	1	1	H9001_037_0	10	Non-Preferred Brand	4	11	1	2	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								91	182	273					86	172	258											91	182	182				86	172	172				86				86			3.03	2.87		3.03	2.87	2.77	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	37	0	1	1	1	H9001_037_0	10	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9001	37	0	1	1	1	H9001_037_0	10	Select Care Drugs	4	11	1	2	6	1		10	1		10	1				30								30			30		31								0							0													0						0						0				0			0	0		0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9003	1	0	1	1	1	H9003_001_0	11	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	1	0	1	1	1	H9003_001_0	11	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H9003	1	0	1	1	1	H9003_001_0	11	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	1	0	1	1	1	H9003_001_0	11	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H9003	1	0	1	1	1	H9003_001_0	11	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	1	0	1	1	1	H9003_001_0	11	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	90	180	270																			90	180	180																90				90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	1	0	1	1	1	H9003_001_0	11	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1740	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	1	0	1	1	1	H9003_001_0	11	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	1	0	1	1	1	H9003_001_0	11	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H9003	6	0	1	1	1	H9003_006_0	11	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	6	0	1	1	1	H9003_006_0	11	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	5	10	15																			5	10	10																5				5		0.16			0.16			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H9003	6	0	1	1	1	H9003_006_0	11	Generic	4	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	6	0	1	1	1	H9003_006_0	11	Generic	4	11	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	10	20	30																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H9003	6	0	1	1	1	H9003_006_0	11	Preferred Brand	4	10	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	45	90	135																			45	90	90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	6	0	1	1	1	H9003_006_0	11	Non-Preferred Brand	4	11	1	2	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	90	180	270																			90	180	180																90				90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	6	0	1	1	1	H9003_006_0	11	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				1857	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	6	0	1	1	1	H9003_006_0	11	Vaccines	4	10	1	2	6	1	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"												
H9003	6	0	1	1	1	H9003_006_0	11	Vaccines	4	10	1	2	6	3	10		1			1	30														30		31	0																																							0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines"										1		
H9047	13	0	2	1	1	H9047_013_0	12	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					4	8	9.6					4	8	9.6																12				12			0.4	0.13	0.13			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	13	0	2	1	1	H9047_013_0	12	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					4	8	9.6					4	8	9.6																12				12			0.4	0.13	0.13			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9047	13	0	2	1	1	H9047_013_0	12	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	28.8					12	24	28.8																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	13	0	2	1	1	H9047_013_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	112.8					47	94	112.8																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	13	0	2	1	1	H9047_013_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	216					90	180	216																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	13	0	2	1	1	H9047_013_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2086.44	33						2086.44	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	37	0	1	1	1	H9047_037_0	11	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					0	0	0					0	0	0																16				16			0.53	0	0			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	37	0	1	1	1	H9047_037_0	11	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	37	0	1	1	1	H9047_037_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	37	0	1	1	1	H9047_037_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	37	0	1	1	1	H9047_037_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2168.18	28						2168.18	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	38	0	1	2	1	H9047_038_0	10	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					0	0	0																12				12			0.4	0	0			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	38	0	1	2	1	H9047_038_0	10	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	38	0	1	2	1	H9047_038_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	90					45	90	90																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	38	0	1	2	1	H9047_038_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	180					90	180	180																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	38	0	1	2	1	H9047_038_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2138.07	30						2138.07	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	39	0	1	2	1	H9047_039_0	10	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					3	6	3					3	6	3																14				14			0.47	0.1	0.1			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	39	0	1	2	1	H9047_039_0	10	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	12					12	24	12																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	39	0	1	2	1	H9047_039_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	90					45	90	90																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	39	0	1	2	1	H9047_039_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	200					100	200	200																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	39	0	1	2	1	H9047_039_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2568.74	28						2568.74	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	45	0	1	1	1	H9047_045_0	9	Preferred Generic	3	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					1	2	2					1	2	2																14				14			0.47	0.03	0.03			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	45	0	1	1	1	H9047_045_0	9	Generic	3	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	36					15	30	36																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	45	0	1	1	1	H9047_045_0	9	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	112.8					47	94	112.8																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	45	0	1	1	1	H9047_045_0	9	Non-Preferred Drug	3	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	240					100	200	240																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	45	0	1	1	1	H9047_045_0	9	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31											1933.33	28						1933.33	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	47	0	1	2	1	H9047_047_0	10	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					4	8	8					4	8	8																14				14			0.47	0.13	0.13			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	47	0	1	2	1	H9047_047_0	10	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					13	26	31.2					13	26	31.2																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	47	0	1	2	1	H9047_047_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	112.8					47	94	112.8																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	47	0	1	2	1	H9047_047_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	240					100	200	240																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	47	0	1	2	1	H9047_047_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2227.21	28						2227.21	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	49	0	1	1	1	H9047_049_0	10	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					0	0	0					0	0	0																16				16			0.53	0	0			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	49	0	1	1	1	H9047_049_0	10	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	24					10	20	24																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	49	0	1	1	1	H9047_049_0	10	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	112.8					47	94	112.8																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	49	0	1	1	1	H9047_049_0	10	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	240					100	200	240																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	49	0	1	1	1	H9047_049_0	10	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2456.61	27						2456.61	27						27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	54	0	1	1	1	H9047_054_0	13	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					0	0	0					0	0	0																16				16			0.53	0	0			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	54	0	1	1	1	H9047_054_0	13	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	54	0	1	1	1	H9047_054_0	13	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	54	0	1	1	1	H9047_054_0	13	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	54	0	1	1	1	H9047_054_0	13	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2158.84	28						2158.84	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	1	1	1	1	H9047_055_1	9	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					0	0	0																12				12			0.4	0	0			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	1	1	1	1	H9047_055_1	9	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					0	0	0																12				12			0.4	0	0			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9047	55	1	1	1	1	H9047_055_1	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	1	1	1	1	H9047_055_1	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	90					45	90	90																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	1	1	1	1	H9047_055_1	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	180					90	180	180																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	1	1	1	1	H9047_055_1	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1684.28	33						1684.28	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	2	1	1	1	H9047_055_2	9	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					0	0	0																12				12			0.4	0	0			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	2	1	1	1	H9047_055_2	9	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					0	0	0					0	0	0																12				12			0.4	0	0			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9047	55	2	1	1	1	H9047_055_2	9	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	2	1	1	1	H9047_055_2	9	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	90					45	90	90																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	2	1	1	1	H9047_055_2	9	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	180					90	180	180																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	55	2	1	1	1	H9047_055_2	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1684.28	33						1684.28	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	1	1	2	1	H9047_056_1	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					4	8	8					4	8	8																14				14			0.47	0.13	0.13			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	1	1	2	1	H9047_056_1	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					13	26	31.2					13	26	31.2																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	1	1	2	1	H9047_056_1	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	112.8					47	94	112.8																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	1	1	2	1	H9047_056_1	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	240					100	200	240																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	1	1	2	1	H9047_056_1	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2247.5	28						2247.5	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	2	1	2	1	H9047_056_2	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								14	28	42					4	8	8					4	8	8																14				14			0.47	0.13	0.13			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	2	1	2	1	H9047_056_2	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					13	26	31.2					13	26	31.2																20				20			0.67	0.43	0.43			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	2	1	2	1	H9047_056_2	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	112.8					47	94	112.8																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	2	1	2	1	H9047_056_2	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	240					100	200	240																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	56	2	1	2	1	H9047_056_2	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2247.5	28						2247.5	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	59	0	1	1	1	H9047_059_0	11	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					0	0	0					0	0	0																16				16			0.53	0	0			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	59	0	1	1	1	H9047_059_0	11	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	59	0	1	1	1	H9047_059_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	59	0	1	1	1	H9047_059_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	59	0	1	1	1	H9047_059_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2122.85	29						2122.85	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	60	0	1	1	1	H9047_060_0	11	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					0	0	0					0	0	0																16				16			0.53	0	0			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	60	0	1	1	1	H9047_060_0	11	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	60	0	1	1	1	H9047_060_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	60	0	1	1	1	H9047_060_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	60	0	1	1	1	H9047_060_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2122.85	29						2122.85	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	62	0	1	1	1	H9047_062_0	12	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					0	0	0					0	0	0																16				16			0.53	0	0			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	62	0	1	1	1	H9047_062_0	12	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	62	0	1	1	1	H9047_062_0	12	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	62	0	1	1	1	H9047_062_0	12	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	62	0	1	1	1	H9047_062_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2122.85	30						2122.85	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	63	0	1	1	1	H9047_063_0	11	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								16	32	48					0	0	0					0	0	0																16				16			0.53	0	0			0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	63	0	1	1	1	H9047_063_0	11	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					10	20	10					10	20	10																20				20			0.67	0.33	0.33			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	63	0	1	1	1	H9047_063_0	11	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					47	94	141					47	94	141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	63	0	1	1	1	H9047_063_0	11	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9047	63	0	1	1	1	H9047_063_0	11	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											2122.85	29						2122.85	29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9065	1	0	1	1	1	H9065_001_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	1	0	1	1	1	H9065_001_0	7	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H9065	1	0	1	1	1	H9065_001_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					7	14	21					7	21	21																7				7			0.23	0.23	0.23			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	1	0	1	1	1	H9065_001_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	1	0	1	1	1	H9065_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	1	0	1	1	1	H9065_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	1	0	1	1	1	H9065_001_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	1	0	1	1	1	H9065_001_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	2	0	1	2	1	H9065_002_0	8	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	2	0	1	2	1	H9065_002_0	8	Preferred Generic	4	1	3	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.15	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		3
H9065	2	0	1	2	1	H9065_002_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					5	10	15					5	10	10																10				10			0.33	0.17	0.17			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	2	0	1	2	1	H9065_002_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	2	0	1	2	1	H9065_002_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	2	0	1	2	1	H9065_002_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	2	0	1	2	1	H9065_002_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	2	0	1	2	1	H9065_002_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	3	0	1	2	1	H9065_003_0	7	Preferred Generic	4	1	3	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	3	0	1	2	1	H9065_003_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	3	0	1	2	1	H9065_003_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	3	0	1	2	1	H9065_003_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	3	0	1	2	1	H9065_003_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	3	0	1	2	1	H9065_003_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	3	0	1	2	1	H9065_003_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	4	0	1	2	1	H9065_004_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					4	8	12					4	8	8																9				9			0.3	0.13	0.13			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	4	0	1	2	1	H9065_004_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								15	30	45					10	20	30					10	20	20																15				15			0.5	0.33	0.33			0.44	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	4	0	1	2	1	H9065_004_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	4	0	1	2	1	H9065_004_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	4	0	1	2	1	H9065_004_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	4	0	1	2	1	H9065_004_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	4	0	1	2	1	H9065_004_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	5	0	1	1	1	H9065_005_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	5	0	1	1	1	H9065_005_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	5	0	1	1	1	H9065_005_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								16	32	48					16	32	48					16	48	48																16				16			0.53	0.53	0.53			0.47	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	5	0	1	1	1	H9065_005_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	5	0	1	1	1	H9065_005_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	5	0	1	1	1	H9065_005_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	5	0	1	1	1	H9065_005_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	5	0	1	1	1	H9065_005_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	6	0	1	1	1	H9065_006_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	6	0	1	1	1	H9065_006_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	6	0	1	1	1	H9065_006_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								16	32	48					16	32	48					16	48	48																16				16			0.53	0.53	0.53			0.47	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	6	0	1	1	1	H9065_006_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	6	0	1	1	1	H9065_006_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	6	0	1	1	1	H9065_006_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	6	0	1	1	1	H9065_006_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	6	0	1	1	1	H9065_006_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	7	0	1	1	1	H9065_007_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	7	0	1	1	1	H9065_007_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9065	7	0	1	1	1	H9065_007_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								16	32	48					16	32	48					16	48	48																16				16			0.53	0.53	0.53			0.47	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	7	0	1	1	1	H9065_007_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					47	94	141					47	141	141																47				47			1.57	1.57	1.57			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	7	0	1	1	1	H9065_007_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	7	0	1	1	1	H9065_007_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												28							28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	7	0	1	1	1	H9065_007_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9065	7	0	1	1	1	H9065_007_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9070	1	0	1	4	1	H9070_001_0	4	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	1	0	1	4	1	H9070_001_0	4	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	1	0	1	4	1	H9070_001_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	1	0	1	4	1	H9070_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	1	0	1	4	1	H9070_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	2	0	1	4	1	H9070_002_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		0				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	2	0	1	4	1	H9070_002_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	2	0	1	4	1	H9070_002_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	2	0	1	4	1	H9070_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	2	0	1	4	1	H9070_002_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	3	0	1	4	1	H9070_003_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	3	0	1	4	1	H9070_003_0	2	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	3	0	1	4	1	H9070_003_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	3	0	1	4	1	H9070_003_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	3	0	1	4	1	H9070_003_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	4	0	1	4	1	H9070_004_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					8		24											10		30				8		0				10				10			0.33	0.27		0.33	0.27	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	4	0	1	4	1	H9070_004_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	4	0	1	4	1	H9070_004_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	4	0	1	4	1	H9070_004_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	4	0	1	4	1	H9070_004_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	5	0	1	4	1	H9070_005_0	2	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	5	0	1	4	1	H9070_005_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	5	0	1	4	1	H9070_005_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	5	0	1	4	1	H9070_005_0	2	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9070	5	0	1	4	1	H9070_005_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9082	7	0	1	1	1	H9082_007_0	7	Preferred Generic	4	11	1	2	1	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9082	7	0	1	1	1	H9082_007_0	7	Generic	4	11	1	2	2	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9082	7	0	1	1	1	H9082_007_0	7	Preferred Brand	4	11	1	2	3	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31	44	88	132																			44	88	132																44				44		1.42			1.42			1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9082	7	0	1	1	1	H9082_007_0	7	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	31	60	90				1	2	31	60	90				31		31				92.12	44	44	44																		44	44	44															44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9082	7	0	1	1	1	H9082_007_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				598.04	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9096	1	0	1	1	1	H9096_001_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	6	12	12																			6	12	12																	6			6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	1	0	1	1	1	H9096_001_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	14	28	28																			14	28	28																	14			14		0.47			0.47			0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	1	0	1	1	1	H9096_001_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47	94	117.5																			47	94	117.5																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	1	0	1	1	1	H9096_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	1	0	1	1	1	H9096_001_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					26																																						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	1	0	1	1	1	H9096_001_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	1	0	1	1	1	H9096_001_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	2	0	1	1	1	H9096_002_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3	6	6																			3	6	6																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	2	0	1	1	1	H9096_002_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	10	20	20																			10	20	20																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	2	0	1	1	1	H9096_002_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47	94	117.5																			47	94	117.5																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	2	0	1	1	1	H9096_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	2	0	1	1	1	H9096_002_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					29																																						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	2	0	1	1	1	H9096_002_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	2	0	1	1	1	H9096_002_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	3	0	1	2	1	H9096_003_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3	6	6																			3	6	6																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	3	0	1	2	1	H9096_003_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	8	16	16																			8	16	16																	8			8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	3	0	1	2	1	H9096_003_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47	94	117.5																			47	94	117.5																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	3	0	1	2	1	H9096_003_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	3	0	1	2	1	H9096_003_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	3	0	1	2	1	H9096_003_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	3	0	1	2	1	H9096_003_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	4	0	1	1	1	H9096_004_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	9	18	18																			9	18	18																	9			9		0.3			0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	4	0	1	1	1	H9096_004_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	20	40	40																			20	40	40																	20			20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	4	0	1	1	1	H9096_004_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47	94	117.5																			47	94	117.5																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	4	0	1	1	1	H9096_004_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	4	0	1	1	1	H9096_004_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					25																																						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	4	0	1	1	1	H9096_004_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	4	0	1	1	1	H9096_004_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	5	0	1	1	1	H9096_005_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3	6	6																			3	6	6																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	5	0	1	1	1	H9096_005_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	8	16	16																			8	16	16																	8			8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	5	0	1	1	1	H9096_005_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	45	90	112.5																			45	90	112.5																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	5	0	1	1	1	H9096_005_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	5	0	1	1	1	H9096_005_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	5	0	1	1	1	H9096_005_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	5	0	1	1	1	H9096_005_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	6	0	1	1	1	H9096_006_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	4	8	8																			4	8	8																	4			4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	6	0	1	1	1	H9096_006_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	15	30	30																			15	30	30																	15			15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	6	0	1	1	1	H9096_006_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47	94	117.5																			47	94	117.5																	47			47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	6	0	1	1	1	H9096_006_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	6	0	1	1	1	H9096_006_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					25																																						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	6	0	1	1	1	H9096_006_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	6	0	1	1	1	H9096_006_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	7	0	1	1	1	H9096_007_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	4	8	8																			4	8	8																	4			4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	7	0	1	1	1	H9096_007_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	10	20	20																			10	20	20																	10			10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	7	0	1	1	1	H9096_007_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	45	90	112.5																			45	90	112.5																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	7	0	1	1	1	H9096_007_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	7	0	1	1	1	H9096_007_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					27																																						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	7	0	1	1	1	H9096_007_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	7	0	1	1	1	H9096_007_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	8	0	1	1	1	H9096_008_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3	6	6																			3	6	6																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	8	0	1	1	1	H9096_008_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	9	18	18																			9	18	18																	9			9		0.3			0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	8	0	1	1	1	H9096_008_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	45	90	112.5																			45	90	112.5																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	8	0	1	1	1	H9096_008_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	8	0	1	1	1	H9096_008_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					29																																						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	8	0	1	1	1	H9096_008_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	8	0	1	1	1	H9096_008_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9096	9	0	1	1	1	H9096_009_0	7	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3	6	6																			3	6	6																	3			3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	9	0	1	1	1	H9096_009_0	7	Generic	4	1	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	6	12	12																			6	12	12																	6			6		0.2			0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	9	0	1	1	1	H9096_009_0	7	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	45	90	112.5																			45	90	112.5																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	9	0	1	1	1	H9096_009_0	7	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100	200	300																			100	200	300																	100			100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	9	0	1	1	1	H9096_009_0	7	Specialty Tier	4	10	1	1	5	1	10		10			1	30															29	31					33																																						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	9	0	1	1	1	H9096_009_0	7	Vaccines	4	11	1	2	6	1	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"												
H9096	9	0	1	1	1	H9096_009_0	7	Vaccines	4	11	1	2	6	3	10		10			1	30															29	31	0																																								0			0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines"										1		
H9104	6	0	1	1	1	H9104_006_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9104	6	0	1	1	1	H9104_006_0	7	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9104	6	0	1	1	1	H9104_006_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					5	10	15					5	10	0																12				12			0.4	0.17	0.17			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9104	6	0	1	1	1	H9104_006_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9104	6	0	1	1	1	H9104_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9104	6	0	1	1	1	H9104_006_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9207	2	0	1	2	1	H9207_002_0	10	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	7	14	14																					14																7				7		0.23						0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9207	2	0	1	2	1	H9207_002_0	10	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9207	2	0	1	2	1	H9207_002_0	10	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	94																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9207	2	0	1	2	1	H9207_002_0	10	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				105.79	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9207	2	0	1	2	1	H9207_002_0	10	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1244.47	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9207	2	0	1	2	1	H9207_002_0	10	Select Care Drugs	4	1	1	2	6	1	111		1	100		1	30	60	90				1	2			90				30		31	0	0	0																					0																0				0		0						0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9207	11	0	1	2	1	H9207_011_0	8	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	7	14	14																					14																7				7		0.23						0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9207	11	0	1	2	1	H9207_011_0	8	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	20	40	40																					40																20				20		0.67						0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9207	11	0	1	2	1	H9207_011_0	8	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	47	94	94																					94																47				47		1.57						1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9207	11	0	1	2	1	H9207_011_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				105.79	25	25	25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9207	11	0	1	2	1	H9207_011_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1244.47	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9276	2	0	1	1	1	H9276_002_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	2	0	1	1	1	H9276_002_0	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	2	0	1	1	1	H9276_002_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	2	0	1	1	1	H9276_002_0	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	2	0	1	1	1	H9276_002_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	2	0	1	1	1	H9276_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	2	0	1	1	1	H9276_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	2	0	1	1	1	H9276_002_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	2	0	1	1	1	H9276_002_0	4	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	4	0	1	1	1	H9276_004_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	4	0	1	1	1	H9276_004_0	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	4	0	1	1	1	H9276_004_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	4	0	1	1	1	H9276_004_0	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	4	0	1	1	1	H9276_004_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					0	0	0					0	0	0																47				47			1.57	0	0			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	4	0	1	1	1	H9276_004_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					45	90	135					45	90	135																100				100			3.33	1.5	1.5			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	4	0	1	1	1	H9276_004_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	4	0	1	1	1	H9276_004_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	4	0	1	1	1	H9276_004_0	4	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	12	0	1	1	1	H9276_012_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	12	0	1	1	1	H9276_012_0	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	12	0	1	1	1	H9276_012_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	12	0	1	1	1	H9276_012_0	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	12	0	1	1	1	H9276_012_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	12	0	1	1	1	H9276_012_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	12	0	1	1	1	H9276_012_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	12	0	1	1	1	H9276_012_0	4	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	12	0	1	1	1	H9276_012_0	4	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	21	0	1	1	1	H9276_021_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	21	0	1	1	1	H9276_021_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	21	0	1	1	1	H9276_021_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	21	0	1	1	1	H9276_021_0	3	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					0	0	0					0	0	0																20				20			0.67	0	0			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9276	21	0	1	1	1	H9276_021_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	21	0	1	1	1	H9276_021_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					100	200	300					100	200	300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	21	0	1	1	1	H9276_021_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	21	0	1	1	1	H9276_021_0	3	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9276	21	0	1	1	1	H9276_021_0	3	Select Care Drugs	4	11	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	30					0	0	0					0	0	0																10				10			0.33	0	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9287	1	0	1	1	1	H9287_001_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								5	10	15					0	0	0					0	0	0																5				5			0.17	0	0			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9287	1	0	1	1	1	H9287_001_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	18																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9287	1	0	1	1	1	H9287_001_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	101																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9287	1	0	1	1	1	H9287_001_0	6	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					90	180	270					90	180	260																100				100			3.33	3	3			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9287	1	0	1	1	1	H9287_001_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9287	1	0	1	1	1	H9287_001_0	6	Select Care Drugs	4	11	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9302	3	0	1	1	1	H9302_003_0	8	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					2	4	6					2	4	4																12				12			0.4	0.07	0.07			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	3	0	1	1	1	H9302_003_0	8	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	36																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	3	0	1	1	1	H9302_003_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	3	0	1	1	1	H9302_003_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											62.62	33	33	33				62.62	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	3	0	1	1	1	H9302_003_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	7	0	1	1	1	H9302_007_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					2	4	6					2	4	4																12				12			0.4	0.07	0.07			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	7	0	1	1	1	H9302_007_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	36																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	7	0	1	1	1	H9302_007_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	7	0	1	1	1	H9302_007_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											66.75	33	33	33				66.75	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	7	0	1	1	1	H9302_007_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	11	0	1	1	1	H9302_011_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					3	6	9					3	6	6																12				12			0.4	0.1	0.1			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	11	0	1	1	1	H9302_011_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					12	24	36					12	24	36																20				20			0.67	0.4	0.4			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	11	0	1	1	1	H9302_011_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					42	84	126					42	84	126																47				47			1.57	1.4	1.4			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	11	0	1	1	1	H9302_011_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											66.07	33	33	33				66.07	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9302	11	0	1	1	1	H9302_011_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1	30						1	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	1	0	1	1	1	H9364_001_0	7	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	1	0	1	1	1	H9364_001_0	7	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	1	0	1	1	1	H9364_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	1	0	1	1	1	H9364_001_0	7	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				95.26	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	1	0	1	1	1	H9364_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	2	0	1	1	1	H9364_002_0	7	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	2	0	1	1	1	H9364_002_0	7	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	2	0	1	1	1	H9364_002_0	7	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	2	0	1	1	1	H9364_002_0	7	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.65	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	2	0	1	1	1	H9364_002_0	7	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	3	0	1	1	1	H9364_003_0	7	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	3	0	1	1	1	H9364_003_0	7	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	3	0	1	1	1	H9364_003_0	7	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	3	0	1	1	1	H9364_003_0	7	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.65	50		50																								50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9364	3	0	1	1	1	H9364_003_0	7	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	1	0	1	1	1	H9403_001_0	6	Preferred Generic	4	1	1	1	1	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	1	0	1	1	1	H9403_001_0	6	Generic	4	1	3	1	2	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	1	0	1	1	1	H9403_001_0	6	Preferred Brand	4	10	1	1	3	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	1	0	1	1	1	H9403_001_0	6	Non-Preferred Drug	4	10	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	1	0	1	1	1	H9403_001_0	6	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31					25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	3	0	1	1	1	H9403_003_0	8	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9403	3	0	1	1	1	H9403_003_0	8	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	15		45																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9403	3	0	1	1	1	H9403_003_0	8	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9403	3	0	1	1	1	H9403_003_0	8	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9403	3	0	1	1	1	H9403_003_0	8	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				653.89	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9403	3	0	1	1	1	H9403_003_0	8	Select Care Drugs	4	10	1	2	6	1	110		1	110		1	30		90				2	2	30		90				30		31	9		27																			9		18																9				9		0.3			0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9403	4	0	1	1	1	H9403_004_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	4	0	1	1	1	H9403_004_0	6	Generic	4	11	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	4	0	1	1	1	H9403_004_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	4	0	1	1	1	H9403_004_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	95		285																			95		190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9403	4	0	1	1	1	H9403_004_0	6	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				631.33	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9408	1	0	1	4	1	H9408_001_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	1	0	1	4	1	H9408_001_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	1	0	1	4	1	H9408_001_0	5	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	1	0	1	4	1	H9408_001_0	5	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	1	0	1	4	1	H9408_001_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1130.83	33						1130.83	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	1	0	1	4	1	H9408_001_0	5	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	5	0	1	4	1	H9408_005_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	5	0	1	4	1	H9408_005_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	5	0	1	4	1	H9408_005_0	4	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	5	0	1	4	1	H9408_005_0	4	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					93	186	279											100	200	300				93	186	279					100			100			3.33	3.1		3.33	3.1	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	5	0	1	4	1	H9408_005_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											836.6	33						836.6	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9408	5	0	1	4	1	H9408_005_0	4	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
H9428	1	0	1	4	1	H9428_001_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9428	1	0	1	4	1	H9428_001_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H9428	1	0	1	4	1	H9428_001_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	15		45																									15		45				15		0				15				15		0.5				0.5	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9428	1	0	1	4	1	H9428_001_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9428	1	0	1	4	1	H9428_001_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				76.27	45		45																								45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9428	1	0	1	4	1	H9428_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					31																										31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9431	1	0	1	4	1	H9431_001_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	1	0	1	4	1	H9431_001_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	1	0	1	4	1	H9431_001_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	1	0	1	4	1	H9431_001_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	1	0	1	4	1	H9431_001_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	1	0	1	4	1	H9431_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	1	0	1	4	1	H9431_001_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											635.61	26						600.11	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	2	0	1	4	1	H9431_002_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	2	0	1	4	1	H9431_002_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	2	0	1	4	1	H9431_002_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	2	0	1	4	1	H9431_002_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	2	0	1	4	1	H9431_002_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	2	0	1	4	1	H9431_002_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	2	0	1	4	1	H9431_002_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											668.17	30						632.39	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	3	0	1	4	1	H9431_003_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	3	0	1	4	1	H9431_003_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	3	0	1	4	1	H9431_003_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	3	0	1	4	1	H9431_003_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	3	0	1	4	1	H9431_003_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	3	0	1	4	1	H9431_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	3	0	1	4	1	H9431_003_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											728.74	33						689.5	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	4	0	1	4	1	H9431_004_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	4	0	1	4	1	H9431_004_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	4	0	1	4	1	H9431_004_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	4	0	1	4	1	H9431_004_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	4	0	1	4	1	H9431_004_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	4	0	1	4	1	H9431_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	4	0	1	4	1	H9431_004_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											689.89	30						657.33	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	5	0	1	4	1	H9431_005_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	5	0	1	4	1	H9431_005_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	5	0	1	4	1	H9431_005_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	5	0	1	4	1	H9431_005_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	5	0	1	4	1	H9431_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	5	0	1	4	1	H9431_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	5	0	1	4	1	H9431_005_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											689.88	30						657.33	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	6	0	1	4	1	H9431_006_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	6	0	1	4	1	H9431_006_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	6	0	1	4	1	H9431_006_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	6	0	1	4	1	H9431_006_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	6	0	1	4	1	H9431_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	6	0	1	4	1	H9431_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	6	0	1	4	1	H9431_006_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											668.26	30						632.41	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	7	0	1	4	1	H9431_007_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	7	0	1	4	1	H9431_007_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	7	0	1	4	1	H9431_007_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	7	0	1	4	1	H9431_007_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	7	0	1	4	1	H9431_007_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	7	0	1	4	1	H9431_007_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	7	0	1	4	1	H9431_007_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.56	33						715.83	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	8	0	1	4	1	H9431_008_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	8	0	1	4	1	H9431_008_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	8	0	1	4	1	H9431_008_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	8	0	1	4	1	H9431_008_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	8	0	1	4	1	H9431_008_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	8	0	1	4	1	H9431_008_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	8	0	1	4	1	H9431_008_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											751.77	33						715.83	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	9	0	1	4	1	H9431_009_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	9	0	1	4	1	H9431_009_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	9	0	1	4	1	H9431_009_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	9	0	1	4	1	H9431_009_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	9	0	1	4	1	H9431_009_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	9	0	1	4	1	H9431_009_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	9	0	1	4	1	H9431_009_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											792.62	33						750.08	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	10	0	1	4	1	H9431_010_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	10	0	1	4	1	H9431_010_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	10	0	1	4	1	H9431_010_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	10	0	1	4	1	H9431_010_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	10	0	1	4	1	H9431_010_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	10	0	1	4	1	H9431_010_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	10	0	1	4	1	H9431_010_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											792.37	33						749.93	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	11	0	1	4	1	H9431_011_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	11	0	1	4	1	H9431_011_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					2	4	5											15	30	45				2	4	5					15			15			0.5	0.07		0.5	0.07	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	11	0	1	4	1	H9431_011_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	11	0	1	4	1	H9431_011_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	10											20	40	60				5	10	10					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	11	0	1	4	1	H9431_011_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	11	0	1	4	1	H9431_011_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	11	0	1	4	1	H9431_011_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											760.49	33						719.39	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	12	0	1	4	1	H9431_012_0	5	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	12	0	1	4	1	H9431_012_0	5	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	12	0	1	4	1	H9431_012_0	5	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	12	0	1	4	1	H9431_012_0	5	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9431	12	0	1	4	1	H9431_012_0	5	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	12	0	1	4	1	H9431_012_0	5	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9431	12	0	1	4	1	H9431_012_0	5	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											760.52	33						719.36	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
H9460	1	0	1	1	1	H9460_001_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								7	14	14					2	4	0											7	14	14				2	4	0				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9460	1	0	1	1	1	H9460_001_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								10	20	20					5	10	10											10	20	20				5	10	0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9460	1	0	1	1	1	H9460_001_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9460	1	0	1	1	1	H9460_001_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.89	46	46	46				85.04	46	46	46										46	46	46				46	46	46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9460	1	0	1	1	1	H9460_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											976.07	33						921.61	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9487	1	0	1	48	5	H9487_001_0	1	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H9487	1	0	1	48	5	H9487_001_0	1	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H9487	1	0	1	48	5	H9487_001_0	1	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H9516	1	0	1	4	1	H9516_001_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	1	0	1	4	1	H9516_001_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		20																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	1	0	1	4	1	H9516_001_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	1	0	1	4	1	H9516_001_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	1	0	1	4	1	H9516_001_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				742.83	29																				29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	1	0	1	4	1	H9516_001_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	1	0	1	4	1	H9516_001_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9516	2	0	1	4	1	H9516_002_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	2	0	1	4	1	H9516_002_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	2	0	1	4	1	H9516_002_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	2	0	1	4	1	H9516_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	2	0	1	4	1	H9516_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				790.23	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	2	0	1	4	1	H9516_002_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9516	2	0	1	4	1	H9516_002_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9525	3	0	1	1	1	H9525_003_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	3	0	1	1	1	H9525_003_0	8	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9525	3	0	1	1	1	H9525_003_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	12	12																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	3	0	1	1	1	H9525_003_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					42	84	126					42	126	126																42				42			1.4	1.4	1.4			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	3	0	1	1	1	H9525_003_0	8	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	3	0	1	1	1	H9525_003_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	3	0	1	1	1	H9525_003_0	8	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	3	0	1	1	1	H9525_003_0	8	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9525	4	0	1	1	1	H9525_004_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					2	4	4																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	4	0	1	1	1	H9525_004_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					9	18	27					9	18	18																14				14			0.47	0.3	0.3			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	4	0	1	1	1	H9525_004_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	4	0	1	1	1	H9525_004_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	4	0	1	1	1	H9525_004_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	4	0	1	1	1	H9525_004_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	4	0	1	1	1	H9525_004_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9525	6	0	1	1	1	H9525_006_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					2	4	4																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	6	0	1	1	1	H9525_006_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					9	18	27					9	18	18																14				14			0.47	0.3	0.3			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	6	0	1	1	1	H9525_006_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	6	0	1	1	1	H9525_006_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	6	0	1	1	1	H9525_006_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												30							30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	6	0	1	1	1	H9525_006_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	6	0	1	1	1	H9525_006_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9525	7	0	1	1	1	H9525_007_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	7	0	1	1	1	H9525_007_0	7	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9525	7	0	1	1	1	H9525_007_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								4	8	12					4	8	12					4	12	12																4				4			0.13	0.13	0.13			0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	7	0	1	1	1	H9525_007_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								33	66	99					33	66	99					33	99	99																33				33			1.1	1.1	1.1			0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	7	0	1	1	1	H9525_007_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	285	285																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	7	0	1	1	1	H9525_007_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	7	0	1	1	1	H9525_007_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	7	0	1	1	1	H9525_007_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9525	8	0	1	1	1	H9525_008_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								7	14	21					2	4	6					2	4	4																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	8	0	1	1	1	H9525_008_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								14	28	42					9	18	27					9	18	18																14				14			0.47	0.3	0.3			0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	8	0	1	1	1	H9525_008_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	8	0	1	1	1	H9525_008_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								100	200	300					95	190	285					95	190	190																100				100			3.33	3.17	3.17			2.94	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	8	0	1	1	1	H9525_008_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	8	0	1	1	1	H9525_008_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9525	8	0	1	1	1	H9525_008_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	1	1	1	4	1	H9572_001_1	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	1	1	4	1	H9572_001_1	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	1	1	4	1	H9572_001_1	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	1	1	4	1	H9572_001_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											61	48		48				64	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	1	1	4	1	H9572_001_1	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	1	1	4	1	H9572_001_1	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	1	1	4	1	H9572_001_1	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	1	2	1	4	1	H9572_001_2	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	2	1	4	1	H9572_001_2	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	2	1	4	1	H9572_001_2	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	2	1	4	1	H9572_001_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											61	48		48				64	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	2	1	4	1	H9572_001_2	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	2	1	4	1	H9572_001_2	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	2	1	4	1	H9572_001_2	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	1	3	1	4	1	H9572_001_3	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	3	1	4	1	H9572_001_3	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	3	1	4	1	H9572_001_3	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	3	1	4	1	H9572_001_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											61	48		48				64	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	3	1	4	1	H9572_001_3	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	3	1	4	1	H9572_001_3	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	3	1	4	1	H9572_001_3	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	1	4	1	4	1	H9572_001_4	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	4	1	4	1	H9572_001_4	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	4	1	4	1	H9572_001_4	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	4	1	4	1	H9572_001_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											61	48		48				64	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	4	1	4	1	H9572_001_4	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	4	1	4	1	H9572_001_4	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	4	1	4	1	H9572_001_4	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	1	6	1	4	1	H9572_001_6	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								7		21					1		3											7		21				1		3				7				7			0.23	0.03		0.23	0.03	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	6	1	4	1	H9572_001_6	9	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								18		54					10		30											18		54				10		30				18				18			0.58	0.32		0.58	0.32	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	6	1	4	1	H9572_001_6	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	6	1	4	1	H9572_001_6	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											61	48		48				64	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	6	1	4	1	H9572_001_6	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	6	1	4	1	H9572_001_6	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	1	6	1	4	1	H9572_001_6	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	2	1	1	4	1	H9572_002_1	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	1	1	4	1	H9572_002_1	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	1	1	4	1	H9572_002_1	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	1	1	4	1	H9572_002_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											65	50		50				64	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	1	1	4	1	H9572_002_1	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	1	1	4	1	H9572_002_1	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	1	1	4	1	H9572_002_1	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	2	2	1	4	1	H9572_002_2	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	2	1	4	1	H9572_002_2	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	2	1	4	1	H9572_002_2	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	2	1	4	1	H9572_002_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											65	50		50				64	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	2	1	4	1	H9572_002_2	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	2	1	4	1	H9572_002_2	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	2	1	4	1	H9572_002_2	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	2	3	1	4	1	H9572_002_3	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	3	1	4	1	H9572_002_3	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	3	1	4	1	H9572_002_3	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	3	1	4	1	H9572_002_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											65	50		50				64	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	3	1	4	1	H9572_002_3	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	3	1	4	1	H9572_002_3	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	3	1	4	1	H9572_002_3	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	2	4	1	4	1	H9572_002_4	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	4	1	4	1	H9572_002_4	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	4	1	4	1	H9572_002_4	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	4	1	4	1	H9572_002_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											65	50		50				64	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	4	1	4	1	H9572_002_4	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	4	1	4	1	H9572_002_4	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	4	1	4	1	H9572_002_4	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	2	6	1	4	1	H9572_002_6	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	6	1	4	1	H9572_002_6	9	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	6	1	4	1	H9572_002_6	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	6	1	4	1	H9572_002_6	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											65	50		50				64	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	6	1	4	1	H9572_002_6	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	31						1	31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	6	1	4	1	H9572_002_6	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	2	6	1	4	1	H9572_002_6	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	3	1	1	4	1	H9572_003_1	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	1	1	4	1	H9572_003_1	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	1	1	4	1	H9572_003_1	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								42		126					37		111											42		126				37		111				42				42			1.35	1.19		1.35	1.19	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	1	1	4	1	H9572_003_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											58	45		45				67	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	1	1	4	1	H9572_003_1	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	1	1	4	1	H9572_003_1	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	1	1	4	1	H9572_003_1	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	3	2	1	4	1	H9572_003_2	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	2	1	4	1	H9572_003_2	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	2	1	4	1	H9572_003_2	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								42		126					37		111											42		126				37		111				42				42			1.35	1.19		1.35	1.19	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	2	1	4	1	H9572_003_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											58	45		45				67	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	2	1	4	1	H9572_003_2	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	2	1	4	1	H9572_003_2	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	2	1	4	1	H9572_003_2	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	3	3	1	4	1	H9572_003_3	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	3	1	4	1	H9572_003_3	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	3	1	4	1	H9572_003_3	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								42		126					37		111											42		126				37		111				42				42			1.35	1.19		1.35	1.19	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	3	1	4	1	H9572_003_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											58	45		45				67	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	3	1	4	1	H9572_003_3	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	3	1	4	1	H9572_003_3	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	3	1	4	1	H9572_003_3	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	3	4	1	4	1	H9572_003_4	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	4	1	4	1	H9572_003_4	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	4	1	4	1	H9572_003_4	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								42		126					37		111											42		126				37		111				42				42			1.35	1.19		1.35	1.19	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	4	1	4	1	H9572_003_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											58	45		45				67	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	4	1	4	1	H9572_003_4	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	4	1	4	1	H9572_003_4	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	4	1	4	1	H9572_003_4	8	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	3	6	1	4	1	H9572_003_6	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	6	1	4	1	H9572_003_6	9	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								12		36					7		21											12		36				7		21				12				12			0.39	0.23		0.39	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	6	1	4	1	H9572_003_6	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								42		126					37		111											42		126				37		111				42				42			1.35	1.19		1.35	1.19	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	6	1	4	1	H9572_003_6	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											58	45		45				67	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	6	1	4	1	H9572_003_6	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	6	1	4	1	H9572_003_6	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	3	6	1	4	1	H9572_003_6	9	Select Care Drugs	4	1	1	2	6	3		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9572	4	1	1	4	1	H9572_004_1	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	1	1	4	1	H9572_004_1	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	1	1	4	1	H9572_004_1	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	1	1	4	1	H9572_004_1	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											86	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	1	1	4	1	H9572_004_1	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	1	1	4	1	H9572_004_1	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	2	1	4	1	H9572_004_2	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	2	1	4	1	H9572_004_2	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	2	1	4	1	H9572_004_2	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	2	1	4	1	H9572_004_2	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											86	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	2	1	4	1	H9572_004_2	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	2	1	4	1	H9572_004_2	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	3	1	4	1	H9572_004_3	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	3	1	4	1	H9572_004_3	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	3	1	4	1	H9572_004_3	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	3	1	4	1	H9572_004_3	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											86	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	3	1	4	1	H9572_004_3	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	3	1	4	1	H9572_004_3	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	4	1	4	1	H9572_004_4	8	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	4	1	4	1	H9572_004_4	8	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	4	1	4	1	H9572_004_4	8	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	4	1	4	1	H9572_004_4	8	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											86	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	4	1	4	1	H9572_004_4	8	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	4	1	4	1	H9572_004_4	8	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	6	1	4	1	H9572_004_6	9	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	6	1	4	1	H9572_004_6	9	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	6	1	4	1	H9572_004_6	9	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	6	1	4	1	H9572_004_6	9	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											86	50		50				85	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	6	1	4	1	H9572_004_6	9	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	29						1	29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9572	4	6	1	4	1	H9572_004_6	9	Select Care Drugs	4	1	1	2	6	1		110	1		110	1				31		90	1	2				31		90	31		31								5		15					0		0											5		15				0		0				5				5			0.16	0		0.16	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9576	1	0	1	48	5	H9576_001_0	5	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H9576	1	0	1	48	5	H9576_001_0	5	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H9576	1	0	1	48	5	H9576_001_0	5	Non-Medicare Rx/OTC Drugs	4	11			3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H9589	1	0	1	4	1	H9589_001_0	9	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9589	1	0	1	4	1	H9589_001_0	9	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	15		45																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9589	1	0	1	4	1	H9589_001_0	9	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9589	1	0	1	4	1	H9589_001_0	9	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	100		300																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9589	1	0	1	4	1	H9589_001_0	9	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				652.83	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9589	1	0	1	4	1	H9589_001_0	9	Select Care Drugs	4	10	1	2	6	1	110		1	110		1	30		90				2	2	30		90				30		31	9		27																			9		18																9				9		0.3			0.3			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9589	3	0	1	4	1	H9589_003_0	9	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				2	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9589	3	0	1	4	1	H9589_003_0	9	Generic	4	1	3	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9589	3	0	1	4	1	H9589_003_0	9	Preferred Brand	4	10	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	45		135																			45		90																45				45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9589	3	0	1	4	1	H9589_003_0	9	Non-Preferred Drug	4	10	1	2	4	1	110		1	110		1	30		90				2	2	30		90				30		31	95		285																			95		190																95				95		3.17			3.17			3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9589	3	0	1	4	1	H9589_003_0	9	Specialty Tier	4	11	1	1	5	1	110		1	110		1	30		90				2	2	30		90				30		31				616.02	28		28																		28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	7	0	1	4	1	H9615_007_0	12	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	7	0	1	4	1	H9615_007_0	12	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9615	7	0	1	4	1	H9615_007_0	12	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	7	0	1	4	1	H9615_007_0	12	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	35		105																			35		70																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	7	0	1	4	1	H9615_007_0	12	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				98.08	27		27																		27		27															27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	7	0	1	4	1	H9615_007_0	12	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1022.32	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	8	0	1	4	1	H9615_008_0	12	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	8	0	1	4	1	H9615_008_0	12	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	12		36																			12		24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	8	0	1	4	1	H9615_008_0	12	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	8	0	1	4	1	H9615_008_0	12	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				99.25	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	8	0	1	4	1	H9615_008_0	12	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				764.19	27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	9	0	1	4	1	H9615_009_0	12	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	9	0	1	4	1	H9615_009_0	12	Preferred Generic	4	1	1	2	1	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9615	9	0	1	4	1	H9615_009_0	12	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	10		30																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	9	0	1	4	1	H9615_009_0	12	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	35		105																			35		70																35				35		1.17			1.17			1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	9	0	1	4	1	H9615_009_0	12	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				97.92	26		26																		26		26															26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	9	0	1	4	1	H9615_009_0	12	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				1016.81	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	10	0	1	4	1	H9615_010_0	12	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	10	0	1	4	1	H9615_010_0	12	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	12		36																			12		24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	10	0	1	4	1	H9615_010_0	12	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	10	0	1	4	1	H9615_010_0	12	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				101.57	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	10	0	1	4	1	H9615_010_0	12	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				755.56	27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	12	0	1	4	1	H9615_012_0	12	Preferred Generic	4	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	12	0	1	4	1	H9615_012_0	12	Generic	4	1	1	2	2	1	110		1	110		1	30		90				2	2	30		90				30		31	12		36																			12		24																12				12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	12	0	1	4	1	H9615_012_0	12	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				2	2	30		90				30		31	47		141																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	12	0	1	4	1	H9615_012_0	12	Non-Preferred Drug	4	11	1	1	4	1	110		1	110		1	30		90				2	2	30		90				30		31				100.35	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9615	12	0	1	4	1	H9615_012_0	12	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				677.11	25																				25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9630	1	0	1	1	1	H9630_001_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	1	0	1	1	1	H9630_001_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			0	0	0																8				8		0.27			0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	1	0	1	1	1	H9630_001_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	1	0	1	1	1	H9630_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	1	0	1	1	1	H9630_001_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	1	0	1	1	1	H9630_001_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	2	0	1	1	1	H9630_002_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	2	0	1	1	1	H9630_002_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			0	0	0																8				8		0.27			0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	2	0	1	1	1	H9630_002_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	2	0	1	1	1	H9630_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	2	0	1	1	1	H9630_002_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	2	0	1	1	1	H9630_002_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	3	0	1	1	1	H9630_003_0	4	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	3	0	1	1	1	H9630_003_0	4	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			0	0	0																8				8		0.27			0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	3	0	1	1	1	H9630_003_0	4	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	3	0	1	1	1	H9630_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	3	0	1	1	1	H9630_003_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	3	0	1	1	1	H9630_003_0	4	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	4	0	1	1	1	H9630_004_0	2	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	4	0	1	1	1	H9630_004_0	2	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			0	0	0																8				8		0.27			0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	4	0	1	1	1	H9630_004_0	2	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	4	0	1	1	1	H9630_004_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	4	0	1	1	1	H9630_004_0	2	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	4	0	1	1	1	H9630_004_0	2	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	5	0	1	1	1	H9630_005_0	2	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	5	0	1	1	1	H9630_005_0	2	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			0	0	0																8				8		0.27			0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	5	0	1	1	1	H9630_005_0	2	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	5	0	1	1	1	H9630_005_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	5	0	1	1	1	H9630_005_0	2	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	5	0	1	1	1	H9630_005_0	2	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	6	0	1	1	1	H9630_006_0	2	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	6	0	1	1	1	H9630_006_0	2	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	8	16	24																			0	0	0																8				8		0.27			0			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	6	0	1	1	1	H9630_006_0	2	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	6	0	1	1	1	H9630_006_0	2	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	6	0	1	1	1	H9630_006_0	2	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9630	6	0	1	1	1	H9630_006_0	2	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	1	1	1	1	H9699_004_1	7	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		20					3		6					3		6																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	1	1	1	1	H9699_004_1	7	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		40					13		26					13		26																20				13			0.67	0.43	0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	1	1	1	1	H9699_004_1	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					40		80					40		80																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	1	1	1	1	H9699_004_1	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											68	50		50				65	48		48				48		48															50			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	1	1	1	1	H9699_004_1	7	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	28		28				1	28		28				28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	1	1	1	1	H9699_004_1	7	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	2	1	1	1	H9699_004_2	7	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		20					3		6					3		6																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	2	1	1	1	H9699_004_2	7	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		40					13		26					13		26																20				13			0.67	0.43	0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	2	1	1	1	H9699_004_2	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					40		80					40		80																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	2	1	1	1	H9699_004_2	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											68	50		50				65	48		48				48		48															50			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	2	1	1	1	H9699_004_2	7	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	28		28				1	28		28				28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	2	1	1	1	H9699_004_2	7	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	3	1	1	1	H9699_004_3	7	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		20					3		6					3		6																10				3			0.33	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	3	1	1	1	H9699_004_3	7	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		40					13		26					13		26																20				13			0.67	0.43	0.43			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	3	1	1	1	H9699_004_3	7	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		94					40		80					40		80																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	3	1	1	1	H9699_004_3	7	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											68	50		50				65	48		48				48		48															50			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	3	1	1	1	H9699_004_3	7	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	28		28				1	28		28				28		28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9699	4	3	1	1	1	H9699_004_3	7	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				30		90	1	2	30		90				30		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9706	1	0	1	1	1	H9706_001_0	5	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	1	0	1	1	1	H9706_001_0	5	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H9706	1	0	1	1	1	H9706_001_0	5	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	1	0	1	1	1	H9706_001_0	5	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	1	0	1	1	1	H9706_001_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	1	0	1	1	1	H9706_001_0	5	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												29		29					29		29												29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	3	0	1	1	1	H9706_003_0	6	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	3	0	1	1	1	H9706_003_0	6	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
H9706	3	0	1	1	1	H9706_003_0	6	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								19		57					8		24													57						24				19				19			0.63	0.27				0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	3	0	1	1	1	H9706_003_0	6	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					39		117													141						117				47				47			1.57	1.3				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	3	0	1	1	1	H9706_003_0	6	Non-Preferred Brand	4	11	1	2	4	1		110	1		100	1				30		90	1	2						90	30		31								100		300					95		285													300						285				100				100			3.33	3.17				3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9706	3	0	1	1	1	H9706_003_0	6	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												27		27					27		27												27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
H9712	1	0	1	48	5	H9712_001_0	7	Generic Drugs	4	1			1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs"	3	0	0	0	0	0	0	0	0			
H9712	1	0	1	48	5	H9712_001_0	7	Brand Drugs	4	10			2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31																																																					"Generic Drugs, Brand Drugs"	3	0	0	0	0	0	0	0	0			
H9725	1	0	1	1	1	H9725_001_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	1	0	1	1	1	H9725_001_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								15	30	45					10	20	20											15	30	45				10	20	0				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	1	0	1	1	1	H9725_001_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	126				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	1	0	1	1	1	H9725_001_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	1	0	1	1	1	H9725_001_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											962.19	33						879.38	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	6	0	1	1	1	H9725_006_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	6	0	1	1	1	H9725_006_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								9	18	27					4	8	8											9	18	27				4	8	0				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	6	0	1	1	1	H9725_006_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								40	80	120					35	70	105											40	80	120				35	70	105				40				40			1.33	1.17		1.33	1.17	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	6	0	1	1	1	H9725_006_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								100	200	300					95	190	285											100	200	300				95	190	285				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9725	6	0	1	1	1	H9725_006_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											959.99	33						879.69	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	2	0	1	1	1	H9730_002_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	2	0	1	1	1	H9730_002_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H9730	2	0	1	1	1	H9730_002_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	2	0	1	1	1	H9730_002_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	2	0	1	1	1	H9730_002_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				82	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	2	0	1	1	1	H9730_002_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	3	0	1	1	1	H9730_003_0	4	Preferred Generic	3	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	3	0	1	1	1	H9730_003_0	4	Generic	3	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	12		36																									12		36				12		0				12				12		0.4				0.4	0.4	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	3	0	1	1	1	H9730_003_0	4	Preferred Brand	3	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	3	0	1	1	1	H9730_003_0	4	Non-Preferred Drug	3	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				98.64	44		44																								44		44				44		44			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	3	0	1	1	1	H9730_003_0	4	Specialty Tier	3	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	4	0	1	1	1	H9730_004_0	4	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	4	0	1	1	1	H9730_004_0	4	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	20		60																									20		60				20		0				20				20		0.67				0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	4	0	1	1	1	H9730_004_0	4	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	4	0	1	1	1	H9730_004_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				91.34	44		44																								44		44				44		44			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	4	0	1	1	1	H9730_004_0	4	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	5	0	1	2	1	H9730_005_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	5	0	1	2	1	H9730_005_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H9730	5	0	1	2	1	H9730_005_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	7		21																									7		21				7		0				7				7		0.23				0.23	0.23	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	5	0	1	2	1	H9730_005_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	45		135																									45		135				45		90				45				45		1.5				1.5	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	5	0	1	2	1	H9730_005_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				84.95	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	5	0	1	2	1	H9730_005_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	7	0	1	1	1	H9730_007_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	7	0	1	1	1	H9730_007_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	7	0	1	1	1	H9730_007_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	7	0	1	1	1	H9730_007_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				78.39	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	7	0	1	1	1	H9730_007_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	9	0	1	1	1	H9730_009_0	5	Preferred Generic	4	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	9	0	1	1	1	H9730_009_0	5	Preferred Generic	4	11	1	2	1	3	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2	2	
H9730	9	0	1	1	1	H9730_009_0	5	Generic	4	11	1	2	2	1	110		1		110	1	30		90				1	2				30		90	30		31	10		30																									10		30				10		0				10				10		0.33				0.33	0.33	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	9	0	1	1	1	H9730_009_0	5	Preferred Brand	4	11	1	2	3	1	110		1		110	1	30		90				1	2				30		90	30		31	47		141																									47		141				47		94				47				47		1.57				1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	9	0	1	1	1	H9730_009_0	5	Non-Preferred Drug	4	11	1	1	4	1	110		1		110	1	30		90				1	2				30		90	30		31				81.27	48		48																								48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9730	9	0	1	1	1	H9730_009_0	5	Specialty Tier	4	11	1	1	5	1	10		1		10	1	30											30			30		31					33																										33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	4	0	1	4	1	H9808_004_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5	10	10																			5	10	10																	5			5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	4	0	1	4	1	H9808_004_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5	10	10																			5	10	10																	5			5		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9808	4	0	1	4	1	H9808_004_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15	30	30																			15	30	30																	15			15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	4	0	1	4	1	H9808_004_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45	90	90																			45	90	90																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	4	0	1	4	1	H9808_004_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90	180	180																			90	180	180																	90			90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	4	0	1	4	1	H9808_004_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				821.2	33	33	33																		33	33	33																33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	5	0	1	4	1	H9808_005_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	5	0	1	4	1	H9808_005_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9808	5	0	1	4	1	H9808_005_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12	24	24																			12	24	24																	12			12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	5	0	1	4	1	H9808_005_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40	80	80																			40	80	80																	40			40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	5	0	1	4	1	H9808_005_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	80	160	160																			80	160	160																	80			80		2.67			2.67			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	5	0	1	4	1	H9808_005_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1095.1	33	33	33																		33	33	33																33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	6	0	1	4	1	H9808_006_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5	10	10																			5	10	10																	5			5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	6	0	1	4	1	H9808_006_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5	10	10																			5	10	10																	5			5		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9808	6	0	1	4	1	H9808_006_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15	30	30																			15	30	30																	15			15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	6	0	1	4	1	H9808_006_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45	90	90																			45	90	90																	45			45		1.5			1.5			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	6	0	1	4	1	H9808_006_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90	180	180																			90	180	180																	90			90		3			3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	6	0	1	4	1	H9808_006_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				821.2	33	33	33																		33	33	33																33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	7	0	1	4	1	H9808_007_0	5	Preferred Generic	4	1	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	7	0	1	4	1	H9808_007_0	5	Preferred Generic	4	1	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0	0	0																			0	0	0																	0			0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9808	7	0	1	4	1	H9808_007_0	5	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12	24	24																			12	24	24																	12			12		0.4			0.4			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	7	0	1	4	1	H9808_007_0	5	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40	80	80																			40	80	80																	40			40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	7	0	1	4	1	H9808_007_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	80	160	160																			80	160	160																	80			80		2.67			2.67			2.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9808	7	0	1	4	1	H9808_007_0	5	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				808.03	33	33	33																		33	33	33																33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9811	1	0	1	1	1	H9811_001_0	5	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	1	0	1	1	1	H9811_001_0	5	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	1	0	1	1	1	H9811_001_0	5	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	42	84	126																			42	84	126																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	1	0	1	1	1	H9811_001_0	5	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	1	0	1	1	1	H9811_001_0	5	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	1	0	1	1	1	H9811_001_0	5	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	5	0	1	1	1	H9811_005_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	5	0	1	1	1	H9811_005_0	3	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	15	30	45																			15	30	45																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	5	0	1	1	1	H9811_005_0	3	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	42	84	126																			42	84	126																42				42		1.4			1.4			1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	5	0	1	1	1	H9811_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	5	0	1	1	1	H9811_005_0	3	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31					27																				27																	27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	5	0	1	1	1	H9811_005_0	3	Select Care Drugs	4	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	6	0	1	1	1	H9811_006_0	4	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	6	0	1	1	1	H9811_006_0	4	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	60																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	6	0	1	1	1	H9811_006_0	4	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	6	0	1	1	1	H9811_006_0	4	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	6	0	1	1	1	H9811_006_0	4	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	6	0	1	1	1	H9811_006_0	4	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	7	0	1	1	1	H9811_007_0	6	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	7	0	1	1	1	H9811_007_0	6	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	7	14	21																			7	14	21																7				7		0.23			0.23			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	7	0	1	1	1	H9811_007_0	6	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	141																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	7	0	1	1	1	H9811_007_0	6	Non-Preferred Drug	3	11	1	2	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	100	200	300																			100	200	300																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	7	0	1	1	1	H9811_007_0	6	Specialty Tier	3	11	1	1	5	1	10		1	10		1	30								30						30		31					26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9811	7	0	1	1	1	H9811_007_0	6	Select Care Drugs	3	11	1	2	6	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9834	1	0	1	1	1	H9834_001_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	1	0	1	1	1	H9834_001_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	1	0	1	1	1	H9834_001_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					113																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	1	0	1	1	1	H9834_001_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				71.53	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	1	0	1	1	1	H9834_001_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	3	0	1	1	1	H9834_003_0	2	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	3	0	1	1	1	H9834_003_0	2	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	3	0	1	1	1	H9834_003_0	2	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					113																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	3	0	1	1	1	H9834_003_0	2	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				82.41	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	3	0	1	1	1	H9834_003_0	2	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	6	0	1	1	1	H9834_006_0	3	Preferred Generic	4	1	1	2	1	1	111		1	100		1	30	60	90				1	2			90				30		31	3	6	9																					7																3				3		0.1						0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	6	0	1	1	1	H9834_006_0	3	Generic	4	1	1	2	2	1	111		1	100		1	30	60	90				1	2			90				30		31	15	30	45																					38																15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	6	0	1	1	1	H9834_006_0	3	Preferred Brand	4	10	1	2	3	1	111		1	100		1	30	60	90				1	2			90				30		31	45	90	135																					113																45				45		1.5						1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	6	0	1	1	1	H9834_006_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	100		1	30	60	90				1	2			90				30		31				81.17	40	40	40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9834	6	0	1	1	1	H9834_006_0	3	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31					33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	1	0	1	1	1	H9861_001_0	16	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		18					2		0					2		0																6				6			0.2	0.07	0.07			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	1	0	1	1	1	H9861_001_0	16	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					10		30					10		30																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	1	0	1	1	1	H9861_001_0	16	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					47		141					47		141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	1	0	1	1	1	H9861_001_0	16	Non-Preferred Drug	4	10	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					100		300					100		300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	1	0	1	1	1	H9861_001_0	16	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1654	30						1654	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	2	0	1	1	1	H9861_002_0	12	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								6		18					2		0					2		0																6				6			0.2	0.07	0.07			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	2	0	1	1	1	H9861_002_0	12	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					10		30					10		30																15				15			0.5	0.33	0.33			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	2	0	1	1	1	H9861_002_0	12	Preferred Brand	4	10	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					47		141					47		141																47				47			1.57	1.57	1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	2	0	1	1	1	H9861_002_0	12	Non-Preferred Drug	4	10	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		300					100		300					100		300																100				100			3.33	3.33	3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9861	2	0	1	1	1	H9861_002_0	12	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											1654	30						1654	30						30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9869	1	0	1	48	5	H9869_001_0	4	Generic Drugs	4	1			1	1	110		1	101		1	30		90				1	1		60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H9869	1	0	1	48	5	H9869_001_0	4	Brand Drugs	4	10			2	1	110		1	101		1	30		90				1	1		60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	1	0	0	0	0	0	0	0	0			
H9869	1	0	1	48	5	H9869_001_0	4	Non-Medicare Rx/OTC Drugs	4	11			3	1	110		1	101		1	30		90				1	1		60	90				30		31																																																					"Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs"	2	0	0	0	0	0	0	0	0			
H9877	2	0	1	1	1	H9877_002_0	4	Preferred Generic	4	1	1	2	1	1	111		1	110		1	31	60	90				1	2	31		90				31		31	2	4	6																			2		2																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	2	0	1	1	1	H9877_002_0	4	Preferred Generic	4	1	1	2	1	3	111		1	110		1	31	60	90				1	2	31		90				31		31	2	4	6																			2		2																2				2		0.06			0			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9877	2	0	1	1	1	H9877_002_0	4	Generic	4	1	1	2	2	1	111		1	110		1	31	60	90				1	2	31		90				31		31	15	30	45																			15		15																15				15		0.48			0.48			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	2	0	1	1	1	H9877_002_0	4	Generic	4	1	1	2	2	3	111		1	110		1	31	60	90				1	2	31		90				31		31	15	30	45																			15		15																15				15		0.48			0.48			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9877	2	0	1	1	1	H9877_002_0	4	Preferred Brand	4	11	1	2	3	1	111		1	110		1	31	60	90				1	2	31		90				31		31	47	94	141																			47		117.5																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	2	0	1	1	1	H9877_002_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	110		1	31	60	90				1	2	31		90				31		31	100	200	300																			100		250																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	2	0	1	1	1	H9877_002_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1228	28																				28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	3	0	1	1	1	H9877_003_0	4	Preferred Generic	4	1	1	2	1	1	111		1	110		1	31	60	90				1	2	31		90				31		31	2	4	6																			2		2																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	3	0	1	1	1	H9877_003_0	4	Preferred Generic	4	1	1	2	1	3	111		1	110		1	31	60	90				1	2	31		90				31		31	2	4	6																			2		2																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9877	3	0	1	1	1	H9877_003_0	4	Generic	4	1	1	2	2	1	111		1	110		1	31	60	90				1	2	31		90				31		31	12	24	36																			12		12																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	3	0	1	1	1	H9877_003_0	4	Generic	4	1	1	2	2	3	111		1	110		1	31	60	90				1	2	31		90				31		31	12	24	36																			12		12																12				12		0.39			0.39			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
H9877	3	0	1	1	1	H9877_003_0	4	Preferred Brand	4	11	1	2	3	1	111		1	110		1	31	60	90				1	2	31		90				31		31	47	94	141																			47		117.5																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	3	0	1	1	1	H9877_003_0	4	Non-Preferred Drug	4	11	1	2	4	1	111		1	110		1	31	60	90				1	2	31		90				31		31	100	200	300																			100		250																100				100		3.23			3.23			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9877	3	0	1	1	1	H9877_003_0	4	Specialty Tier	4	11	1	1	5	1	10		1	10		1	31								31						31		31				1360	31																				31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
H9878	1	0	1	4	1	H9878_001_0	6	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	1	0	1	4	1	H9878_001_0	6	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	15		30																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	1	0	1	4	1	H9878_001_0	6	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	1	0	1	4	1	H9878_001_0	6	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	1	0	1	4	1	H9878_001_0	6	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				776.1	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	1	0	1	4	1	H9878_001_0	6	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	1	0	1	4	1	H9878_001_0	6	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9878	2	0	1	4	1	H9878_002_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	2	0	1	4	1	H9878_002_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	8		16																			8		16																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	2	0	1	4	1	H9878_002_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	2	0	1	4	1	H9878_002_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	2	0	1	4	1	H9878_002_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				758.92	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	2	0	1	4	1	H9878_002_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	2	0	1	4	1	H9878_002_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9878	3	0	1	4	1	H9878_003_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	3	0	1	4	1	H9878_003_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	15		30																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	3	0	1	4	1	H9878_003_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	3	0	1	4	1	H9878_003_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	3	0	1	4	1	H9878_003_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				768.39	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	3	0	1	4	1	H9878_003_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	3	0	1	4	1	H9878_003_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9878	6	0	1	4	1	H9878_006_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	6	0	1	4	1	H9878_006_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	15		30																			15		30																15				15		0.5			0.5			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	6	0	1	4	1	H9878_006_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	6	0	1	4	1	H9878_006_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	6	0	1	4	1	H9878_006_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				768.86	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	6	0	1	4	1	H9878_006_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	6	0	1	4	1	H9878_006_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
H9878	7	0	1	4	1	H9878_007_0	7	Preferred Generic	4	11	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	4		8																			4		8																4				4		0.13			0.13			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	7	0	1	4	1	H9878_007_0	7	Generic	4	11	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	10		20																			10		20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	7	0	1	4	1	H9878_007_0	7	Preferred Brand	4	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	47		94																			47		94																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	7	0	1	4	1	H9878_007_0	7	Non-Preferred Drug	4	11	1	2	4	1	110		1	110		1	30		90				1	2	30		90				30		31	100		200																			100		200																100				100		3.33			3.33			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	7	0	1	4	1	H9878_007_0	7	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				719.01	30																				30																	30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	7	0	1	4	1	H9878_007_0	7	Select Care Drugs	4	11	1	2	6	1	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
H9878	7	0	1	4	1	H9878_007_0	7	Select Care Drugs	4	11	1	2	6	3	110		1	110		1	30		90				1	2	30		90				30		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
R0110	2	0	1	31	11	R0110_002_0	4	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	2	0	1	31	11	R0110_002_0	4	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					14		42											20		60				14		0				20				20			0.67	0.47		0.67	0.47	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	2	0	1	31	11	R0110_002_0	4	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	2	0	1	31	11	R0110_002_0	4	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	2	0	1	31	11	R0110_002_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	3	0	1	31	11	R0110_003_0	6	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	3	0	1	31	11	R0110_003_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	3	0	1	31	11	R0110_003_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	3	0	1	31	11	R0110_003_0	6	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0110	3	0	1	31	11	R0110_003_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0759	1	0	1	31	11	R0759_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0759	1	0	1	31	11	R0759_001_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		42																											42						28				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0759	1	0	1	31	11	R0759_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0759	1	0	1	31	11	R0759_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0759	1	0	1	31	11	R0759_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				767	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0802	1	0	1	31	11	R0802_001_0	7	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					2	4	6					2	4	0																4				4			0.13	0.07	0.07			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0802	1	0	1	31	11	R0802_001_0	7	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								18	36	54					10	20	30					10	20	20																18				18			0.6	0.33	0.33			0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0802	1	0	1	31	11	R0802_001_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0802	1	0	1	31	11	R0802_001_0	7	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	237.5																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0802	1	0	1	31	11	R0802_001_0	7	Specialty Tier	4	10	1	1	5	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											600	28	28	28				600	28	28	28				28	28	28															28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0865	3	0	1	31	11	R0865_003_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0865	3	0	1	31	11	R0865_003_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0865	3	0	1	31	11	R0865_003_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0865	3	0	1	31	11	R0865_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0865	3	0	1	31	11	R0865_003_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0923	2	0	1	31	11	R0923_002_0	5	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0923	2	0	1	31	11	R0923_002_0	5	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0923	2	0	1	31	11	R0923_002_0	5	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0923	2	0	1	31	11	R0923_002_0	5	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R0923	2	0	1	31	11	R0923_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1390	2	0	1	31	11	R1390_002_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1390	2	0	1	31	11	R1390_002_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1390	2	0	1	31	11	R1390_002_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1390	2	0	1	31	11	R1390_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1390	2	0	1	31	11	R1390_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1532	2	0	1	31	11	R1532_002_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1532	2	0	1	31	11	R1532_002_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1532	2	0	1	31	11	R1532_002_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1532	2	0	1	31	11	R1532_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R1532	2	0	1	31	11	R1532_002_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	1	0	1	31	11	R2604_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		8																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	1	0	1	31	11	R2604_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	14		28																											42						0				14				14		0.46						0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	1	0	1	31	11	R2604_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	1	0	1	31	11	R2604_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	1	0	1	31	11	R2604_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				850	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	3	0	1	31	11	R2604_003_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		8																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	3	0	1	31	11	R2604_003_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	3	0	1	31	11	R2604_003_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	3	0	1	31	11	R2604_003_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R2604	3	0	1	31	11	R2604_003_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				830	29		29																										29						29			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3332	1	0	1	31	11	R3332_001_0	9	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R3332	1	0	1	31	11	R3332_001_0	9	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	2	31		90				31		31								10		30					0		0					0		0																10				0			0.32	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
R3332	1	0	1	31	11	R3332_001_0	9	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	2	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R3332	1	0	1	31	11	R3332_001_0	9	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	2	31		90				31		31								47		141					40		120					40		120																47				40			1.52	1.29	1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R3332	1	0	1	31	11	R3332_001_0	9	Non-Preferred Drug	4	11	1	2	4	1		110	1	110		1				31		90	1	2	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R3332	1	0	1	31	11	R3332_001_0	9	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											937.63	28						937.63	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R3332	1	0	1	31	11	R3332_001_0	9	Select Care Drugs	4	1	1	2	6	1		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R3332	1	0	1	31	11	R3332_001_0	9	Select Care Drugs	4	1	1	2	6	3		110	1	110		1				31		90	1	2	31		90				31		31								0		0					0		0					0		0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
R3392	2	0	1	31	11	R3392_002_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3392	2	0	1	31	11	R3392_002_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3392	2	0	1	31	11	R3392_002_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3392	2	0	1	31	11	R3392_002_0	4	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3392	2	0	1	31	11	R3392_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	8	0	1	31	11	R3444_008_0	4	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31				1	20		20																				20															20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	8	0	1	31	11	R3444_008_0	4	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31				5	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	8	0	1	31	11	R3444_008_0	4	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31				50	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	8	0	1	31	11	R3444_008_0	4	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				45	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	8	0	1	31	11	R3444_008_0	4	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31				509	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	9	0	1	31	11	R3444_009_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		10																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	9	0	1	31	11	R3444_009_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	15		37.5																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	9	0	1	31	11	R3444_009_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	9	0	1	31	11	R3444_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	9	0	1	31	11	R3444_009_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				788	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	12	0	1	31	11	R3444_012_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		10																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	12	0	1	31	11	R3444_012_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	15		37.5																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	12	0	1	31	11	R3444_012_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	12	0	1	31	11	R3444_012_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	12	0	1	31	11	R3444_012_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				809	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	23	0	1	31	11	R3444_023_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		10																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	23	0	1	31	11	R3444_023_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	15		37.5																											45						0				15				15		0.5						0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	23	0	1	31	11	R3444_023_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	23	0	1	31	11	R3444_023_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3444	23	0	1	31	11	R3444_023_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				847	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3887	2	0	1	31	11	R3887_002_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3887	2	0	1	31	11	R3887_002_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3887	2	0	1	31	11	R3887_002_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3887	2	0	1	31	11	R3887_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R3887	2	0	1	31	11	R3887_002_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	3	0	1	31	11	R4182_003_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	3	0	1	31	11	R4182_003_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	3	0	1	31	11	R4182_003_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	3	0	1	31	11	R4182_003_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	3	0	1	31	11	R4182_003_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	4	0	1	31	11	R4182_004_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	4	0	1	31	11	R4182_004_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					13		39											20		60				13		0				20				20			0.67	0.43		0.67	0.43	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	4	0	1	31	11	R4182_004_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	4	0	1	31	11	R4182_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					99		297											100		300				99		287				100				100			3.33	3.3		3.33	3.3	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4182	4	0	1	31	11	R4182_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4487	1	0	1	31	11	R4487_001_0	7	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					6	12	18					6	12	12																11				11			0.37	0.2	0.2			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R4487	1	0	1	31	11	R4487_001_0	7	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R4487	1	0	1	31	11	R4487_001_0	7	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R4487	1	0	1	31	11	R4487_001_0	7	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											62.41	47	47	47				61.08	46	46	46				46	46	46															47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R4487	1	0	1	31	11	R4487_001_0	7	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												31							31						31																	31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R4487	1	0	1	31	11	R4487_001_0	7	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R4487	1	0	1	31	11	R4487_001_0	7	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
R4845	2	0	1	31	11	R4845_002_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4845	2	0	1	31	11	R4845_002_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					12		36											20		60				12		0				20				20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4845	2	0	1	31	11	R4845_002_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4845	2	0	1	31	11	R4845_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R4845	2	0	1	31	11	R4845_002_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5329	1	0	1	31	11	R5329_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5329	1	0	1	31	11	R5329_001_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5329	1	0	1	31	11	R5329_001_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
R5329	1	0	1	31	11	R5329_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5329	1	0	1	31	11	R5329_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5329	1	0	1	31	11	R5329_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				865	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	1	0	1	31	11	R5342_001_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	1	0	1	31	11	R5342_001_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	1	0	1	31	11	R5342_001_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	1	0	1	31	11	R5342_001_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	1	0	1	31	11	R5342_001_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				743	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	5	0	1	31	11	R5342_005_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	5	0	1	31	11	R5342_005_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	5	0	1	31	11	R5342_005_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	5	0	1	31	11	R5342_005_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	5	0	1	31	11	R5342_005_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				893	28		28																										28						28			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	6	0	1	31	11	R5342_006_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		9																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	6	0	1	31	11	R5342_006_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	6	0	1	31	11	R5342_006_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	6	0	1	31	11	R5342_006_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5342	6	0	1	31	11	R5342_006_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				908	30		30																										30						30			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5361	2	0	1	31	11	R5361_002_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					3		9											10		30				3		0				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5361	2	0	1	31	11	R5361_002_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					9		27											20		60				9		0				20				20			0.67	0.3		0.67	0.3	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5361	2	0	1	31	11	R5361_002_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5361	2	0	1	31	11	R5361_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5361	2	0	1	31	11	R5361_002_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5495	2	0	1	31	11	R5495_002_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								16		48					16		48											16		48				16		0				16				16			0.53	0.53		0.53	0.53	0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5495	2	0	1	31	11	R5495_002_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					19		57											20		60				19		0				20				20			0.67	0.63		0.67	0.63	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5495	2	0	1	31	11	R5495_002_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5495	2	0	1	31	11	R5495_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5495	2	0	1	31	11	R5495_002_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	5	0	1	31	11	R5826_005_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		0				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	5	0	1	31	11	R5826_005_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					15		45											20		60				15		0				20				20			0.67	0.5		0.67	0.5	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	5	0	1	31	11	R5826_005_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					45		135											47		141				45		125				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	5	0	1	31	11	R5826_005_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	5	0	1	31	11	R5826_005_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	74	0	1	31	11	R5826_074_0	3	Preferred Generic	4	11	3	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					6		18											10		30				6		0				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	74	0	1	31	11	R5826_074_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	74	0	1	31	11	R5826_074_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	74	0	1	31	11	R5826_074_0	3	Non-Preferred Drug	4	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5826	74	0	1	31	11	R5826_074_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R5941	14	0	1	31	11	R5941_014_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					6	12	18					0	0	0																11				11			0.37	0.2	0			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R5941	14	0	1	31	11	R5941_014_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								20	40	60					15	30	45					15	30	30																20				20			0.67	0.5	0.5			0.59	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R5941	14	0	1	31	11	R5941_014_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					42	84	126					42	84	84																47				47			1.57	1.4	1.4			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R5941	14	0	1	31	11	R5941_014_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											58.46	42	42	42				57.07	41	41	41				41	41	41															42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R5941	14	0	1	31	11	R5941_014_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												29							29						29																	29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R5941	14	0	1	31	11	R5941_014_0	6	Select Care Drugs	4	1	1	2	6	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
R5941	14	0	1	31	11	R5941_014_0	6	Select Care Drugs	4	1	1	2	6	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								0	0	0					0	0	0					0	0	0																0				0			0	0	0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
R6694	3	0	1	31	11	R6694_003_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	3	0	1	31	11	R6694_003_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
R6694	3	0	1	31	11	R6694_003_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	3	0	1	31	11	R6694_003_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					0	0	0											20	40	60				0	0	0					20			20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
R6694	3	0	1	31	11	R6694_003_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	3	0	1	31	11	R6694_003_0	4	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	3	0	1	31	11	R6694_003_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											664.85	33						616.54	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	5	0	1	31	11	R6694_005_0	4	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	5	0	1	31	11	R6694_005_0	4	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	25											20	40	60				10	20	25					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	5	0	1	31	11	R6694_005_0	4	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	5	0	1	31	11	R6694_005_0	4	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	5	0	1	31	11	R6694_005_0	4	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											664.38	30						618.32	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	6	0	1	31	11	R6694_006_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	6	0	1	31	11	R6694_006_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					0	0	0											15	30	45				0	0	0					15			15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
R6694	6	0	1	31	11	R6694_006_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	6	0	1	31	11	R6694_006_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					5	10	15											20	40	60				5	10	15					20			20			0.67	0.17		0.67	0.17	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
R6694	6	0	1	31	11	R6694_006_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	6	0	1	31	11	R6694_006_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100	200	300					100	200	300											100	200	300				100	200	300					100			100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6694	6	0	1	31	11	R6694_006_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											693.33	28						637.56	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
R6801	8	0	1	31	11	R6801_008_0	2	Preferred Generic	4	1	1	1	1	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	8	0	1	31	11	R6801_008_0	2	Generic	4	1	1	1	2	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	8	0	1	31	11	R6801_008_0	2	Preferred Brand	4	11	1	1	3	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	8	0	1	31	11	R6801_008_0	2	Non-Preferred Drug	4	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	8	0	1	31	11	R6801_008_0	2	Specialty Tier	4	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	9	0	1	31	11	R6801_009_0	3	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	9	0	1	31	11	R6801_009_0	3	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	9	0	1	31	11	R6801_009_0	3	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	9	0	1	31	11	R6801_009_0	3	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	9	0	1	31	11	R6801_009_0	3	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				662	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	12	0	1	31	11	R6801_012_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	4		12																											12						0				4				4		0.13						0.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	12	0	1	31	11	R6801_012_0	4	Generic	4	1	1	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		36																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	12	0	1	31	11	R6801_012_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	12	0	1	31	11	R6801_012_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R6801	12	0	1	31	11	R6801_012_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				667	25		25																										25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7220	2	0	1	31	11	R7220_002_0	2	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								19		57					13		39											19		57				13		0				19				19			0.63	0.43		0.63	0.43	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7220	2	0	1	31	11	R7220_002_0	2	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					20		60											20		60				20		0				20				20			0.67	0.67		0.67	0.67	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7220	2	0	1	31	11	R7220_002_0	2	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7220	2	0	1	31	11	R7220_002_0	2	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					100		300											100		300				100		290				100				100			3.33	3.33		3.33	3.33	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7220	2	0	1	31	11	R7220_002_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7315	2	0	1	31	11	R7315_002_0	3	Preferred Generic	3	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					7		21											10		30				7		0				10				10			0.33	0.23		0.33	0.23	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7315	2	0	1	31	11	R7315_002_0	3	Generic	3	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					17		51											20		60				17		0				20				20			0.67	0.57		0.67	0.57	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7315	2	0	1	31	11	R7315_002_0	3	Preferred Brand	3	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		131				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7315	2	0	1	31	11	R7315_002_0	3	Non-Preferred Drug	3	11	1	2	4	1		110	1		110	1				30		90	2	2				30		90	30		31								100		300					95		285											100		300				95		275				100				100			3.33	3.17		3.33	3.17	3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7315	2	0	1	31	11	R7315_002_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7444	1	0	1	31	11	R7444_001_0	4	Preferred Generic	4	1	1	2	1	1	110		1		100	1	30		90				2	2						90	30		31	3		6																											9						0				3				3		0.1						0.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7444	1	0	1	31	11	R7444_001_0	4	Generic	4	1	3	2	2	1	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7444	1	0	1	31	11	R7444_001_0	4	Generic	4	1	3	2	2	3	110		1		100	1	30		90				2	2						90	30		31	12		24																											36						0				12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										2		2
R7444	1	0	1	31	11	R7444_001_0	4	Preferred Brand	4	11	1	2	3	1	110		1		100	1	30		90				2	2						90	30		31	47		141																											141						131				47				47		1.56						1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7444	1	0	1	31	11	R7444_001_0	4	Non-Preferred Drug	4	11	1	2	4	1	110		1		100	1	30		90				2	2						90	30		31	100		300																											300						290				100				100		3.33						3.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
R7444	1	0	1	31	11	R7444_001_0	4	Specialty Tier	4	11	1	1	5	1	110		1		100	1	30		90				2	2						90	30		31				735	27		27																										27						27			27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	1	0		29	10	S1030_001_0	1	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								9		27					2		4					2		4																9				9			0.3	0.06	0.06			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S1030	1	0		29	10	S1030_001_0	1	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								17		51					10		20					10		20																17				17			0.56	0.33	0.33			0.54	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S1030	1	0		29	10	S1030_001_0	1	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					40		80					40		80																47				47			1.56	1.33	1.33			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S1030	1	0		29	10	S1030_001_0	1	Non-Preferred Brand	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											67	50		50				40	45		45				45		45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S1030	1	0		29	10	S1030_001_0	1	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	33		33				1	33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S1030	6	0		29	10	S1030_006_0	1	Preferred Generic	2	1	1	2	1	1	110		1	110		1	30		90				1	2	30		90				30		31	1		3																			1		2																1				1		0.03			0.03			0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	6	0		29	10	S1030_006_0	1	Generic	2	1	1	2	2	1	110		1	110		1	30		90				1	2	30		90				30		31	2		6																			2		4																2				2		0.06			0.06			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	6	0		29	10	S1030_006_0	1	Preferred Brand	2	11	1	2	3	1	110		1	110		1	30		90				1	2	30		90				30		31	38		114																			38		76																38				38		1.26			1.26			1.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	6	0		29	10	S1030_006_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1	110		1	30		90				1	2	30		90				30		31				56	50		50																		50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	6	0		29	10	S1030_006_0	1	Specialty Tier	2	11	1	1	5	1	110		1	110		1	30		90				1	2	30		90				30		31				56	25		25																		25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	10	0		29	10	S1030_010_0	1	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								9		27					2		4					2		4																9				9			0.3	0.06	0.06			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	10	0		29	10	S1030_010_0	1	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								15		45					8		16					8		16																15				15			0.5	0.26	0.26			0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	10	0		29	10	S1030_010_0	1	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		141					40		80					40		80																47				47			1.56	1.33	1.33			1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	10	0		29	10	S1030_010_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											66	50		50				59	45		45				45		45															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1030	10	0		29	10	S1030_010_0	1	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	25		25				1	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1894	1	0		29	10	S1894_001_0	3	Preferred Generic	3	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								8	16	24					0	0	0											8	16	16				0	0	0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1894	1	0		29	10	S1894_001_0	3	Generic	3	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								16	32	48					6	12	18											16	32	32				6	12	12				16				16			0.53	0.2		0.53	0.2	0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1894	1	0		29	10	S1894_001_0	3	Preferred Brand	3	11	1	1	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											33.45	25	25	25				13.38	10	10	10										25	25	25				10	10	10			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1894	1	0		29	10	S1894_001_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											105.23	25	25	25				105.23	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S1894	1	0		29	10	S1894_001_0	3	Specialty Tier	3	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											1662.57	25	25	25				1662.57	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	3	0		29	10	S2468_003_0	3	Preferred Generic	3	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								8	16	24					2	4	4							4																8				8			0.27	0.07				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	3	0		29	10	S2468_003_0	3	Generic	3	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								15	30	45					6	12	12							12																15				15			0.5	0.2				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	3	0		29	10	S2468_003_0	3	Preferred Brand	3	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								42	84	126					35	70	70							70																42				42			1.4	1.17				1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	3	0		29	10	S2468_003_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1	100		1				30	60	90	2	2			90				30		31											77.02	43	43	43				53.26	40	40	40						40															43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	3	0		29	10	S2468_003_0	3	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31											674.37	25						674.37	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	4	0		29	10	S2468_004_0	3	Preferred Generic	4	1	1	2	1	1		111	1	100		1				30	60	90	1	2			90				30		31								11	22	33					2	4	4							4																11				11			0.37	0.07				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	4	0		29	10	S2468_004_0	3	Generic	4	1	1	2	2	1		111	1	100		1				30	60	90	2	2			90				30		31								14	28	42					7	14	14							14																14				14			0.47	0.23				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	4	0		29	10	S2468_004_0	3	Preferred Brand	4	11	1	2	3	1		111	1	100		1				30	60	90	2	2			90				30		31								47	94	141					40	80	80							80																47				47			1.57	1.33				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	4	0		29	10	S2468_004_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	100		1				30	60	90	2	2			90				30		31											66.37	29	29	29				55.01	27	27	27						27															29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2468	4	0		29	10	S2468_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											844.96	33						844.96	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	5	0		29	10	S2668_005_0	3	Preferred Generic	2	11	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	6	9																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	5	0		29	10	S2668_005_0	3	Generic	2	11	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	8	16	24																			8	16	24																8				8		0.27			0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	5	0		29	10	S2668_005_0	3	Preferred Brand	2	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	38	76	114																			38	76	114																38				38		1.27			1.27			1.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	5	0		29	10	S2668_005_0	3	Non-Preferred Drug	2	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				42.84	40	40	40																		40	40	40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	5	0		29	10	S2668_005_0	3	Specialty Tier	2	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				536.87	25	25	25																		25	25	25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	6	0		29	10	S2668_006_0	3	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	6	0		29	10	S2668_006_0	3	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31								13	26	39					6	12	18					6	12	18																13				13			0.43	0.2	0.2			0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	6	0		29	10	S2668_006_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31								45	90	135					35	70	105					35	70	105																45				45			1.5	1.17	1.17			1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	6	0		29	10	S2668_006_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31											38.8	50	50	50				27.79	35	35	35				35	35	35															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2668	6	0		29	10	S2668_006_0	3	Specialty Tier	4	11	1	1	5	1		111	1	111		1				30	60	90	2	2	30	60	90				30		31											608.67	33	33	33				486.86	33	33	33				33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	1	0		29	10	S2874_001_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	1	0		29	10	S2874_001_0	2	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	1	0		29	10	S2874_001_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	1	0		29	10	S2874_001_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											70	50		50				59	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	1	0		29	10	S2874_001_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												29							29												29						29					29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	4	0		29	10	S2874_004_0	2	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	4	0		29	10	S2874_004_0	2	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	4	0		29	10	S2874_004_0	2	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				24	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	4	0		29	10	S2874_004_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				56	42		42																								42		42				42		30			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2874	4	0		29	10	S2874_004_0	2	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	1	0		29	10	S2893_001_0	5	Preferred Generic	3	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								7	14	21					2	4	6					2	2	2																7				7			0.23	0.07	0.07			0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	1	0		29	10	S2893_001_0	5	Generic	3	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								19	38	57					8	16	24					8	16	16																19				19			0.63	0.27	0.27			0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	1	0		29	10	S2893_001_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					37	74	111					37	74	74																47				47			1.57	1.23	1.23			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	1	0		29	10	S2893_001_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											91.48	50	50	50				77.74	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	1	0		29	10	S2893_001_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	3	0		29	10	S2893_003_0	6	Preferred Generic	4	11	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	1	1																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	3	0		29	10	S2893_003_0	6	Preferred Generic	4	11	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								6	12	18					1	2	3					1	1	1																6				6			0.2	0.03	0.03			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S2893	3	0		29	10	S2893_003_0	6	Generic	4	11	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	14																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	3	0		29	10	S2893_003_0	6	Generic	4	11	1	2	2	3		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					7	14	21					7	14	14																12				12			0.4	0.23	0.23			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S2893	3	0		29	10	S2893_003_0	6	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								40	80	120					30	60	90					30	60	60																40				40			1.33	1	1			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	3	0		29	10	S2893_003_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											76.35	45	45	45				63.07	35	35	35				35	35	35															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S2893	3	0		29	10	S2893_003_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	2	0		29	10	S4607_002_0	3	Preferred Generic	2	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	20					1	2	2.5					1	2	2.5																8				8			0.27	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	2	0		29	10	S4607_002_0	3	Generic	2	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	22.5					2	4	5					2	4	5																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	2	0		29	10	S4607_002_0	3	Preferred Brand	2	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								40	80	100					25	50	62.5					25	50	62.5																40				40			1.33	0.83	0.83			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	2	0		29	10	S4607_002_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											39.03	42	42	42				40.37	42	42	42				42	42	42															42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	2	0		29	10	S4607_002_0	3	Specialty Tier	2	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	3	0		29	10	S4607_003_0	2	Preferred Generic	2	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	20					1	2	2.5					1	2	2.5																8				8			0.27	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	3	0		29	10	S4607_003_0	2	Generic	2	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	22.5					2	4	5					2	4	5																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	3	0		29	10	S4607_003_0	2	Preferred Brand	2	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								40	80	100					30	60	75					30	60	75																40				40			1.33	1	1			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	3	0		29	10	S4607_003_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											36.11	46	46	46				29.85	46	46	46				46	46	46															46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	3	0		29	10	S4607_003_0	2	Specialty Tier	2	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	9	0		29	10	S4607_009_0	2	Preferred Generic	2	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	20					1	2	2.5					1	2	2.5																8				8			0.27	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	9	0		29	10	S4607_009_0	2	Generic	2	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	22.5					2	4	5					2	4	5																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	9	0		29	10	S4607_009_0	2	Preferred Brand	2	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								40	80	100					27	54	67.5					27	54	67.5																40				40			1.33	0.9	0.9			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	9	0		29	10	S4607_009_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											32.46	43	43	43				32.28	43	43	43				43	43	43															43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	9	0		29	10	S4607_009_0	2	Specialty Tier	2	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	23	0		29	10	S4607_023_0	2	Preferred Generic	2	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								8	16	20					1	2	2.5					1	2	2.5																8				8			0.27	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	23	0		29	10	S4607_023_0	2	Generic	2	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								9	18	22.5					2	4	5					2	4	5																9				9			0.3	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	23	0		29	10	S4607_023_0	2	Preferred Brand	2	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								40	80	100					25	50	62.5					25	50	62.5																40				40			1.33	0.83	0.83			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	23	0		29	10	S4607_023_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											34.16	42	42	42				30.11	42	42	42				42	42	42															42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4607	23	0		29	10	S4607_023_0	2	Specialty Tier	2	11	1	1	5	1		10	1	10		1				30					30						30		31												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	12	0		29	10	S4802_012_0	9	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	12	0		29	10	S4802_012_0	9	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	12	0		29	10	S4802_012_0	9	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								42		126					30		90											42		126				30		75				42				42			1.4	1		1.4	1	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	12	0		29	10	S4802_012_0	9	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											95.74	45		45				72.34	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	12	0		29	10	S4802_012_0	9	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	13	0		29	10	S4802_013_0	7	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	13	0		29	10	S4802_013_0	7	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	13	0		29	10	S4802_013_0	7	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					32		96											40		120				32		80				40				40			1.33	1.07		1.33	1.07	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	13	0		29	10	S4802_013_0	7	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											98.43	45		45				74.37	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	13	0		29	10	S4802_013_0	7	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	14	0		29	10	S4802_014_0	5	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	14	0		29	10	S4802_014_0	5	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	14	0		29	10	S4802_014_0	5	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								42		126					32		96											42		126				32		80				42				42			1.4	1.07		1.4	1.07	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	14	0		29	10	S4802_014_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											95.54	45		45				70.06	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	14	0		29	10	S4802_014_0	5	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	20	0		29	10	S4802_020_0	5	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	20	0		29	10	S4802_020_0	5	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					1		3											2		6				1		2.5				2				2			0.07	0.03		0.07	0.03	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	20	0		29	10	S4802_020_0	5	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					29		87											40		120				29		72.5				40				40			1.33	0.97		1.33	0.97	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	20	0		29	10	S4802_020_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											88.91	45		45				65.2	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	20	0		29	10	S4802_020_0	5	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	21	0		29	10	S4802_021_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	21	0		29	10	S4802_021_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					1		3											3		9				1		2.5				3				3			0.1	0.03		0.1	0.03	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	21	0		29	10	S4802_021_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								43		129					31		93											43		129				31		77.5				43				43			1.43	1.03		1.43	1.03	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	21	0		29	10	S4802_021_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											98.61	44		44				73.96	33		33										44		44				33		33			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	21	0		29	10	S4802_021_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	69	0		29	10	S4802_069_0	5	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	69	0		29	10	S4802_069_0	5	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	69	0		29	10	S4802_069_0	5	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					33		99											45		135				33		82.5				45				45			1.5	1.1		1.5	1.1	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	69	0		29	10	S4802_069_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											95.77	46		46				70.78	34		34										46		46				34		34			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	69	0		29	10	S4802_069_0	5	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	70	0		29	10	S4802_070_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	70	0		29	10	S4802_070_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					3		9											5		15				3		7.5				5				5			0.17	0.1		0.17	0.1	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	70	0		29	10	S4802_070_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					32		96											47		141				32		80				47				47			1.57	1.07		1.57	1.07	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	70	0		29	10	S4802_070_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											92.16	47		47				64.71	33		33										47		47				33		33			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	70	0		29	10	S4802_070_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	71	0		29	10	S4802_071_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	71	0		29	10	S4802_071_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					2		6											4		12				2		5				4				4			0.13	0.07		0.13	0.07	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	71	0		29	10	S4802_071_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								46		138					31		93											46		138				31		77.5				46				46			1.53	1.03		1.53	1.03	1.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	71	0		29	10	S4802_071_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											96.51	45		45				72.92	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	71	0		29	10	S4802_071_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	72	0		29	10	S4802_072_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	72	0		29	10	S4802_072_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	72	0		29	10	S4802_072_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					33		99											47		141				33		82.5				47				47			1.57	1.1		1.57	1.1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	72	0		29	10	S4802_072_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											97.76	43		43				77.3	34		34										43		43				34		34			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	72	0		29	10	S4802_072_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	73	0		29	10	S4802_073_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	73	0		29	10	S4802_073_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					1		3											3		9				1		2.5				3				3			0.1	0.03		0.1	0.03	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	73	0		29	10	S4802_073_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								43		129					30		90											43		129				30		75				43				43			1.43	1		1.43	1	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	73	0		29	10	S4802_073_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											90.21	45		45				66.15	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	73	0		29	10	S4802_073_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	74	0		29	10	S4802_074_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	74	0		29	10	S4802_074_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					2		6											4		12				2		5				4				4			0.13	0.07		0.13	0.07	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	74	0		29	10	S4802_074_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								44		132					33		99											44		132				33		82.5				44				44			1.47	1.1		1.47	1.1	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	74	0		29	10	S4802_074_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											98.29	44		44				75.95	34		34										44		44				34		34			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	74	0		29	10	S4802_074_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	75	0		29	10	S4802_075_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	75	0		29	10	S4802_075_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	75	0		29	10	S4802_075_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					34		102											47		141				34		85				47				47			1.57	1.13		1.57	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	75	0		29	10	S4802_075_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											93.38	45		45				68.48	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	75	0		29	10	S4802_075_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	76	0		29	10	S4802_076_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	76	0		29	10	S4802_076_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	76	0		29	10	S4802_076_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								43		129					32		96											43		129				32		80				43				43			1.43	1.07		1.43	1.07	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	76	0		29	10	S4802_076_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											92.34	45		45				69.77	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	76	0		29	10	S4802_076_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	77	0		29	10	S4802_077_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	77	0		29	10	S4802_077_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					3		9											5		15				3		7.5				5				5			0.17	0.1		0.17	0.1	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	77	0		29	10	S4802_077_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					33		99											47		141				33		82.5				47				47			1.57	1.1		1.57	1.1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	77	0		29	10	S4802_077_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											97.67	45		45				71.62	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	77	0		29	10	S4802_077_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	78	0		29	10	S4802_078_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	78	0		29	10	S4802_078_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	78	0		29	10	S4802_078_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					33		99											45		135				33		82.5				45				45			1.5	1.1		1.5	1.1	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	78	0		29	10	S4802_078_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											98	45		45				74.05	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	78	0		29	10	S4802_078_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	79	0		29	10	S4802_079_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	79	0		29	10	S4802_079_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								6		18					3		9											6		18				3		7.5				6				6			0.2	0.1		0.2	0.1	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	79	0		29	10	S4802_079_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					34		102											47		141				34		85				47				47			1.57	1.13		1.57	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	79	0		29	10	S4802_079_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											90.67	45		45				66.49	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	79	0		29	10	S4802_079_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	80	0		29	10	S4802_080_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	80	0		29	10	S4802_080_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								6		18					3		9											6		18				3		7.5				6				6			0.2	0.1		0.2	0.1	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	80	0		29	10	S4802_080_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					34		102											45		135				34		85				45				45			1.5	1.13		1.5	1.13	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	80	0		29	10	S4802_080_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											89.64	45		45				67.73	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	80	0		29	10	S4802_080_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	81	0		29	10	S4802_081_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	81	0		29	10	S4802_081_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								6		18					3		9											6		18				3		7.5				6				6			0.2	0.1		0.2	0.1	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	81	0		29	10	S4802_081_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								46		138					31		93											46		138				31		77.5				46				46			1.53	1.03		1.53	1.03	1.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	81	0		29	10	S4802_081_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											97.88	45		45				76.13	35		35										45		45				35		35			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	81	0		29	10	S4802_081_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	82	0		29	10	S4802_082_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	82	0		29	10	S4802_082_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					2		6											4		12				2		5				4				4			0.13	0.07		0.13	0.07	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	82	0		29	10	S4802_082_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								46		138					31		93											46		138				31		77.5				46				46			1.53	1.03		1.53	1.03	1.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	82	0		29	10	S4802_082_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											83.81	45		45				61.46	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	82	0		29	10	S4802_082_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	83	0		29	10	S4802_083_0	5	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	83	0		29	10	S4802_083_0	5	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					2		6											4		12				2		5				4				4			0.13	0.07		0.13	0.07	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	83	0		29	10	S4802_083_0	5	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								43		129					30		90											43		129				30		75				43				43			1.43	1		1.43	1	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	83	0		29	10	S4802_083_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											90.95	45		45				66.7	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	83	0		29	10	S4802_083_0	5	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	84	0		29	10	S4802_084_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	84	0		29	10	S4802_084_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	84	0		29	10	S4802_084_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								41		123					30		90											41		123				30		75				41				41			1.37	1		1.37	1	1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	84	0		29	10	S4802_084_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											91.79	45		45				67.32	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	84	0		29	10	S4802_084_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	85	0		29	10	S4802_085_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	85	0		29	10	S4802_085_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	85	0		29	10	S4802_085_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								46		138					31		93											46		138				31		77.5				46				46			1.53	1.03		1.53	1.03	1.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	85	0		29	10	S4802_085_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											99.91	45		45				75.49	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	85	0		29	10	S4802_085_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	86	0		29	10	S4802_086_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	86	0		29	10	S4802_086_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	86	0		29	10	S4802_086_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					32		96											47		141				32		80				47				47			1.57	1.07		1.57	1.07	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	86	0		29	10	S4802_086_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											96.88	45		45				73.2	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	86	0		29	10	S4802_086_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	87	0		29	10	S4802_087_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	87	0		29	10	S4802_087_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	87	0		29	10	S4802_087_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					32		96											45		135				32		80				45				45			1.5	1.07		1.5	1.07	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	87	0		29	10	S4802_087_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											86.61	45		45				67.36	35		35										45		45				35		35			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	87	0		29	10	S4802_087_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	88	0		29	10	S4802_088_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	88	0		29	10	S4802_088_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	88	0		29	10	S4802_088_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								44		132					30		90											44		132				30		75				44				44			1.47	1		1.47	1	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	88	0		29	10	S4802_088_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											94.21	45		45				69.09	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	88	0		29	10	S4802_088_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	89	0		29	10	S4802_089_0	5	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	89	0		29	10	S4802_089_0	5	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	89	0		29	10	S4802_089_0	5	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								46		138					30		90											46		138				30		75				46				46			1.53	1		1.53	1	1.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	89	0		29	10	S4802_089_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											92.05	45		45				67.5	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	89	0		29	10	S4802_089_0	5	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	90	0		29	10	S4802_090_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	90	0		29	10	S4802_090_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	90	0		29	10	S4802_090_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								43		129					31		93											43		129				31		77.5				43				43			1.43	1.03		1.43	1.03	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	90	0		29	10	S4802_090_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											80.54	45		45				59.06	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	90	0		29	10	S4802_090_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	91	0		29	10	S4802_091_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	91	0		29	10	S4802_091_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	91	0		29	10	S4802_091_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					30		90											40		120				30		75				40				40			1.33	1		1.33	1	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	91	0		29	10	S4802_091_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											90.77	44		44				66.02	32		32										44		44				32		32			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	91	0		29	10	S4802_091_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	92	0		29	10	S4802_092_0	5	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	92	0		29	10	S4802_092_0	5	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	92	0		29	10	S4802_092_0	5	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								42		126					30		90											42		126				30		75				42				42			1.4	1		1.4	1	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	92	0		29	10	S4802_092_0	5	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.35	45		45				61.85	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	92	0		29	10	S4802_092_0	5	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	93	0		29	10	S4802_093_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								1		3					0		0											1		3				0		0				1				1			0.03	0		0.03	0	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	93	0		29	10	S4802_093_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					2		6											4		12				2		5				4				4			0.13	0.07		0.13	0.07	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	93	0		29	10	S4802_093_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					30		90											47		141				30		75				47				47			1.57	1		1.57	1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	93	0		29	10	S4802_093_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											96.38	50		50				63.61	33		33										50		50				33		33			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	93	0		29	10	S4802_093_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	94	0		29	10	S4802_094_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	94	0		29	10	S4802_094_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	94	0		29	10	S4802_094_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								44		132					31		93											44		132				31		77.5				44				44			1.47	1.03		1.47	1.03	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	94	0		29	10	S4802_094_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											99.3	45		45				75.03	34		34										45		45				34		34			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	94	0		29	10	S4802_094_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	95	0		29	10	S4802_095_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	95	0		29	10	S4802_095_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								7		21					2		6											7		21				2		5				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	95	0		29	10	S4802_095_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					32		96											47		141				32		80				47				47			1.57	1.07		1.57	1.07	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	95	0		29	10	S4802_095_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											99.32	43		43				78.53	34		34										43		43				34		34			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	95	0		29	10	S4802_095_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	96	0		29	10	S4802_096_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	96	0		29	10	S4802_096_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	96	0		29	10	S4802_096_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								43		129					31		93											43		129				31		77.5				43				43			1.43	1.03		1.43	1.03	1.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	96	0		29	10	S4802_096_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											95.91	45		45				70.33	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	96	0		29	10	S4802_096_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	97	0		29	10	S4802_097_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	97	0		29	10	S4802_097_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								4		12					1		3											4		12				1		2.5				4				4			0.13	0.03		0.13	0.03	0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	97	0		29	10	S4802_097_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					31		93											45		135				31		77.5				45				45			1.5	1.03		1.5	1.03	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	97	0		29	10	S4802_097_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											96.51	45		45				70.77	33		33										45		45				33		33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	97	0		29	10	S4802_097_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	132	0		29	10	S4802_132_0	7	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	132	0		29	10	S4802_132_0	7	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	132	0		29	10	S4802_132_0	7	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	132	0		29	10	S4802_132_0	7	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											65.08	50		50				61.18	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	132	0		29	10	S4802_132_0	7	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	133	0		29	10	S4802_133_0	6	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	133	0		29	10	S4802_133_0	6	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								9		27					4		12											9		27				4		10				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	133	0		29	10	S4802_133_0	6	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	133	0		29	10	S4802_133_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											61.18	50		50				57.51	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	133	0		29	10	S4802_133_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	134	0		29	10	S4802_134_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	134	0		29	10	S4802_134_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					10		30											15		45				10		25				15				15			0.5	0.33		0.5	0.33	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	134	0		29	10	S4802_134_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	134	0		29	10	S4802_134_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.13	50		50				79.08	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	134	0		29	10	S4802_134_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	135	0		29	10	S4802_135_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	135	0		29	10	S4802_135_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								9		27					4		12											9		27				4		10				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	135	0		29	10	S4802_135_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	135	0		29	10	S4802_135_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											71.76	50		50				67.45	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	135	0		29	10	S4802_135_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	136	0		29	10	S4802_136_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	136	0		29	10	S4802_136_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	136	0		29	10	S4802_136_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	136	0		29	10	S4802_136_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.9	50		50				46.9	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	136	0		29	10	S4802_136_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	137	0		29	10	S4802_137_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	137	0		29	10	S4802_137_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	137	0		29	10	S4802_137_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	137	0		29	10	S4802_137_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											52.48	50		50				49.34	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	137	0		29	10	S4802_137_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	138	0		29	10	S4802_138_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	138	0		29	10	S4802_138_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	138	0		29	10	S4802_138_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	138	0		29	10	S4802_138_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											55.69	50		50				52.35	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	138	0		29	10	S4802_138_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	139	0		29	10	S4802_139_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	139	0		29	10	S4802_139_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	139	0		29	10	S4802_139_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	139	0		29	10	S4802_139_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.86	50		50				46.9	49		49										50		50				49		49			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	139	0		29	10	S4802_139_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	140	0		29	10	S4802_140_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	140	0		29	10	S4802_140_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	140	0		29	10	S4802_140_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	140	0		29	10	S4802_140_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											51.32	50		50				48.24	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	140	0		29	10	S4802_140_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	141	0		29	10	S4802_141_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	141	0		29	10	S4802_141_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	141	0		29	10	S4802_141_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	141	0		29	10	S4802_141_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.79	50		50				46.8	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	141	0		29	10	S4802_141_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	142	0		29	10	S4802_142_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	142	0		29	10	S4802_142_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	142	0		29	10	S4802_142_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	142	0		29	10	S4802_142_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.92	50		50				45.04	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	142	0		29	10	S4802_142_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	143	0		29	10	S4802_143_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	143	0		29	10	S4802_143_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	143	0		29	10	S4802_143_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	143	0		29	10	S4802_143_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.8	50		50				48.8	49		49										50		50				49		49			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	143	0		29	10	S4802_143_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	144	0		29	10	S4802_144_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	144	0		29	10	S4802_144_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	144	0		29	10	S4802_144_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	144	0		29	10	S4802_144_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											52.46	50		50				49.31	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	144	0		29	10	S4802_144_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	145	0		29	10	S4802_145_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	145	0		29	10	S4802_145_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	145	0		29	10	S4802_145_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	145	0		29	10	S4802_145_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											52.02	50		50				48.9	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	145	0		29	10	S4802_145_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	146	0		29	10	S4802_146_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	146	0		29	10	S4802_146_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	146	0		29	10	S4802_146_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	146	0		29	10	S4802_146_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											48.82	50		50				45.89	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	146	0		29	10	S4802_146_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	147	0		29	10	S4802_147_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	147	0		29	10	S4802_147_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	147	0		29	10	S4802_147_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	147	0		29	10	S4802_147_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.36	50		50				46.4	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	147	0		29	10	S4802_147_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	148	0		29	10	S4802_148_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	148	0		29	10	S4802_148_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	148	0		29	10	S4802_148_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	148	0		29	10	S4802_148_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											51.32	50		50				48.24	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	148	0		29	10	S4802_148_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	149	0		29	10	S4802_149_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	149	0		29	10	S4802_149_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	149	0		29	10	S4802_149_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	149	0		29	10	S4802_149_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											48.54	50		50				45.62	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	149	0		29	10	S4802_149_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	150	0		29	10	S4802_150_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	150	0		29	10	S4802_150_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	150	0		29	10	S4802_150_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	150	0		29	10	S4802_150_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.19	50		50				46.24	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	150	0		29	10	S4802_150_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	151	0		29	10	S4802_151_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	151	0		29	10	S4802_151_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	151	0		29	10	S4802_151_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	151	0		29	10	S4802_151_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											51.18	50		50				49.13	48		48										50		50				48		48			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	151	0		29	10	S4802_151_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	152	0		29	10	S4802_152_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	152	0		29	10	S4802_152_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	152	0		29	10	S4802_152_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	152	0		29	10	S4802_152_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											48.34	50		50				45.44	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	152	0		29	10	S4802_152_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	153	0		29	10	S4802_153_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	153	0		29	10	S4802_153_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								9		27					4		12											9		27				4		10				9				9			0.3	0.13		0.3	0.13	0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	153	0		29	10	S4802_153_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	153	0		29	10	S4802_153_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.91	50		50				46.92	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	153	0		29	10	S4802_153_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	154	0		29	10	S4802_154_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	154	0		29	10	S4802_154_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	154	0		29	10	S4802_154_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	154	0		29	10	S4802_154_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											51.8	50		50				48.69	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	154	0		29	10	S4802_154_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	155	0		29	10	S4802_155_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	155	0		29	10	S4802_155_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	155	0		29	10	S4802_155_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	155	0		29	10	S4802_155_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											52.36	50		50				51.31	49		49										50		50				49		49			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	155	0		29	10	S4802_155_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	156	0		29	10	S4802_156_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	156	0		29	10	S4802_156_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	156	0		29	10	S4802_156_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	156	0		29	10	S4802_156_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.67	50		50				46.69	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	156	0		29	10	S4802_156_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	157	0		29	10	S4802_157_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	157	0		29	10	S4802_157_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		12.5				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	157	0		29	10	S4802_157_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	157	0		29	10	S4802_157_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											48.04	50		50				45.16	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	157	0		29	10	S4802_157_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	158	0		29	10	S4802_158_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	158	0		29	10	S4802_158_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	158	0		29	10	S4802_158_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	158	0		29	10	S4802_158_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											48.08	50		50				45.19	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	158	0		29	10	S4802_158_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	159	0		29	10	S4802_159_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	159	0		29	10	S4802_159_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	159	0		29	10	S4802_159_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	159	0		29	10	S4802_159_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											58.29	50		50				54.79	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	159	0		29	10	S4802_159_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	160	0		29	10	S4802_160_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	160	0		29	10	S4802_160_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		12.5				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	160	0		29	10	S4802_160_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	160	0		29	10	S4802_160_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.82	50		50				47.83	48		48										50		50				48		48			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	160	0		29	10	S4802_160_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	161	0		29	10	S4802_161_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	161	0		29	10	S4802_161_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					5		15											10		30				5		12.5				10				10			0.33	0.17		0.33	0.17	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	161	0		29	10	S4802_161_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	161	0		29	10	S4802_161_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											53.65	50		50				51.51	48		48										50		50				48		48			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	161	0		29	10	S4802_161_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	162	0		29	10	S4802_162_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	162	0		29	10	S4802_162_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	162	0		29	10	S4802_162_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	162	0		29	10	S4802_162_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											49.39	50		50				46.43	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	162	0		29	10	S4802_162_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	163	0		29	10	S4802_163_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	163	0		29	10	S4802_163_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					7		21											12		36				7		17.5				12				12			0.4	0.23		0.4	0.23	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	163	0		29	10	S4802_163_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	163	0		29	10	S4802_163_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											52.64	50		50				49.48	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	163	0		29	10	S4802_163_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	164	0		29	10	S4802_164_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	164	0		29	10	S4802_164_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								13		39					8		24											13		39				8		20				13				13			0.43	0.27		0.43	0.27	0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	164	0		29	10	S4802_164_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	164	0		29	10	S4802_164_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											57.58	50		50				56.42	49		49										50		50				49		49			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	164	0		29	10	S4802_164_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	165	0		29	10	S4802_165_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					0		0											5		15				0		0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	165	0		29	10	S4802_165_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								11		33					6		18											11		33				6		15				11				11			0.37	0.2		0.37	0.2	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	165	0		29	10	S4802_165_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	165	0		29	10	S4802_165_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											56.76	50		50				53.36	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	165	0		29	10	S4802_165_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	170	0		29	10	S4802_170_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	170	0		29	10	S4802_170_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	170	0		29	10	S4802_170_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	170	0		29	10	S4802_170_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.07	50		50				43.3	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	170	0		29	10	S4802_170_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	171	0		29	10	S4802_171_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	171	0		29	10	S4802_171_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					8		24											15		45				8		20				15				15			0.5	0.27		0.5	0.27	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	171	0		29	10	S4802_171_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	171	0		29	10	S4802_171_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	171	0		29	10	S4802_171_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	172	0		29	10	S4802_172_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	172	0		29	10	S4802_172_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	172	0		29	10	S4802_172_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	172	0		29	10	S4802_172_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	172	0		29	10	S4802_172_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	173	0		29	10	S4802_173_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	173	0		29	10	S4802_173_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	173	0		29	10	S4802_173_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					41		123											47		141				41		102.5				47				47			1.57	1.37		1.57	1.37	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	173	0		29	10	S4802_173_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.08	50		50				45.2	48		48										50		50				48		48			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	173	0		29	10	S4802_173_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	174	0		29	10	S4802_174_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	174	0		29	10	S4802_174_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					8		24											15		45				8		20				15				15			0.5	0.27		0.5	0.27	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	174	0		29	10	S4802_174_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	174	0		29	10	S4802_174_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	174	0		29	10	S4802_174_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	175	0		29	10	S4802_175_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	175	0		29	10	S4802_175_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	175	0		29	10	S4802_175_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	175	0		29	10	S4802_175_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	175	0		29	10	S4802_175_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	176	0		29	10	S4802_176_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	176	0		29	10	S4802_176_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					7		21											15		45				7		17.5				15				15			0.5	0.23		0.5	0.23	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	176	0		29	10	S4802_176_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	176	0		29	10	S4802_176_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	176	0		29	10	S4802_176_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	177	0		29	10	S4802_177_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	177	0		29	10	S4802_177_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	177	0		29	10	S4802_177_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	177	0		29	10	S4802_177_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.09	50		50				45.2	48		48										50		50				48		48			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	177	0		29	10	S4802_177_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	178	0		29	10	S4802_178_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	178	0		29	10	S4802_178_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					8		24											15		45				8		20				15				15			0.5	0.27		0.5	0.27	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	178	0		29	10	S4802_178_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	178	0		29	10	S4802_178_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	178	0		29	10	S4802_178_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	179	0		29	10	S4802_179_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	179	0		29	10	S4802_179_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					7		21											15		45				7		17.5				15				15			0.5	0.23		0.5	0.23	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	179	0		29	10	S4802_179_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					39		117											47		141				39		97.5				47				47			1.57	1.3		1.57	1.3	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	179	0		29	10	S4802_179_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	179	0		29	10	S4802_179_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	180	0		29	10	S4802_180_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	180	0		29	10	S4802_180_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	180	0		29	10	S4802_180_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					42		126											47		141				42		105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	180	0		29	10	S4802_180_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	180	0		29	10	S4802_180_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	181	0		29	10	S4802_181_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	181	0		29	10	S4802_181_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	181	0		29	10	S4802_181_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	181	0		29	10	S4802_181_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	181	0		29	10	S4802_181_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	182	0		29	10	S4802_182_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	182	0		29	10	S4802_182_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	182	0		29	10	S4802_182_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	182	0		29	10	S4802_182_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.07	50		50				43.3	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	182	0		29	10	S4802_182_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	183	0		29	10	S4802_183_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	183	0		29	10	S4802_183_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	183	0		29	10	S4802_183_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	183	0		29	10	S4802_183_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	183	0		29	10	S4802_183_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	184	0		29	10	S4802_184_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	184	0		29	10	S4802_184_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	184	0		29	10	S4802_184_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	184	0		29	10	S4802_184_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	184	0		29	10	S4802_184_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	185	0		29	10	S4802_185_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	185	0		29	10	S4802_185_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					7		21											15		45				7		17.5				15				15			0.5	0.23		0.5	0.23	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	185	0		29	10	S4802_185_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					43		129											47		141				43		107.5				47				47			1.57	1.43		1.57	1.43	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	185	0		29	10	S4802_185_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.07	50		50				44.24	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	185	0		29	10	S4802_185_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	186	0		29	10	S4802_186_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	186	0		29	10	S4802_186_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	186	0		29	10	S4802_186_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					41		123											47		141				41		102.5				47				47			1.57	1.37		1.57	1.37	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	186	0		29	10	S4802_186_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	186	0		29	10	S4802_186_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	187	0		29	10	S4802_187_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	187	0		29	10	S4802_187_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					3		9											15		45				3		7.5				15				15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	187	0		29	10	S4802_187_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	187	0		29	10	S4802_187_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	187	0		29	10	S4802_187_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	188	0		29	10	S4802_188_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	188	0		29	10	S4802_188_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	188	0		29	10	S4802_188_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					41		123											47		141				41		102.5				47				47			1.57	1.37		1.57	1.37	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	188	0		29	10	S4802_188_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	188	0		29	10	S4802_188_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	189	0		29	10	S4802_189_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	189	0		29	10	S4802_189_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	189	0		29	10	S4802_189_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	189	0		29	10	S4802_189_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.08	50		50				45.2	48		48										50		50				48		48			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	189	0		29	10	S4802_189_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	190	0		29	10	S4802_190_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	190	0		29	10	S4802_190_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	190	0		29	10	S4802_190_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	190	0		29	10	S4802_190_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	190	0		29	10	S4802_190_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	191	0		29	10	S4802_191_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	191	0		29	10	S4802_191_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					4		12											15		45				4		10				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	191	0		29	10	S4802_191_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	191	0		29	10	S4802_191_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	191	0		29	10	S4802_191_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	192	0		29	10	S4802_192_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	192	0		29	10	S4802_192_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	192	0		29	10	S4802_192_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	192	0		29	10	S4802_192_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.07	50		50				43.3	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	192	0		29	10	S4802_192_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	193	0		29	10	S4802_193_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	193	0		29	10	S4802_193_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					7		21											15		45				7		17.5				15				15			0.5	0.23		0.5	0.23	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	193	0		29	10	S4802_193_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	193	0		29	10	S4802_193_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	193	0		29	10	S4802_193_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	194	0		29	10	S4802_194_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	194	0		29	10	S4802_194_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					4		12											15		45				4		10				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	194	0		29	10	S4802_194_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	194	0		29	10	S4802_194_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.05	50		50				44.23	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	194	0		29	10	S4802_194_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	195	0		29	10	S4802_195_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	195	0		29	10	S4802_195_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					4		12											15		45				4		10				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	195	0		29	10	S4802_195_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					39		117											47		141				39		97.5				47				47			1.57	1.3		1.57	1.3	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	195	0		29	10	S4802_195_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				44.23	47		47										50		50				47		47			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	195	0		29	10	S4802_195_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	196	0		29	10	S4802_196_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	196	0		29	10	S4802_196_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	196	0		29	10	S4802_196_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					38		114											47		141				38		95				47				47			1.57	1.27		1.57	1.27	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	196	0		29	10	S4802_196_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.04	50		50				43.27	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	196	0		29	10	S4802_196_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	197	0		29	10	S4802_197_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	197	0		29	10	S4802_197_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					6		18											15		45				6		15				15				15			0.5	0.2		0.5	0.2	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	197	0		29	10	S4802_197_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	197	0		29	10	S4802_197_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.07	50		50				43.3	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	197	0		29	10	S4802_197_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	198	0		29	10	S4802_198_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	198	0		29	10	S4802_198_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					8		24											15		45				8		20				15				15			0.5	0.27		0.5	0.27	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	198	0		29	10	S4802_198_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					41		123											47		141				41		102.5				47				47			1.57	1.37		1.57	1.37	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	198	0		29	10	S4802_198_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.08	50		50				45.19	48		48										50		50				48		48			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	198	0		29	10	S4802_198_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	199	0		29	10	S4802_199_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	199	0		29	10	S4802_199_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	199	0		29	10	S4802_199_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	199	0		29	10	S4802_199_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	199	0		29	10	S4802_199_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	200	0		29	10	S4802_200_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	200	0		29	10	S4802_200_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	200	0		29	10	S4802_200_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	200	0		29	10	S4802_200_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	200	0		29	10	S4802_200_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	201	0		29	10	S4802_201_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	201	0		29	10	S4802_201_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	201	0		29	10	S4802_201_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	201	0		29	10	S4802_201_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	201	0		29	10	S4802_201_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	202	0		29	10	S4802_202_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	202	0		29	10	S4802_202_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	202	0		29	10	S4802_202_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	202	0		29	10	S4802_202_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	202	0		29	10	S4802_202_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	203	0		29	10	S4802_203_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								8		24					0		0											8		24				0		0				8				8			0.27	0		0.27	0	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	203	0		29	10	S4802_203_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					5		15											15		45				5		12.5				15				15			0.5	0.17		0.5	0.17	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	203	0		29	10	S4802_203_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					40		120											47		141				40		100				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	203	0		29	10	S4802_203_0	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											47.06	50		50				43.29	46		46										50		50				46		46			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S4802	203	0		29	10	S4802_203_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	2	0		29	10	S5540_002_0	4	Preferred Generic	3	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	12				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	2	0		29	10	S5540_002_0	4	Generic	3	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					8	16	24											20	40	60				8	16	24				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	2	0		29	10	S5540_002_0	4	Preferred Brand	3	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					37	74	111											47	94	141				37	74	111				47				47			1.57	1.23		1.57	1.23	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	2	0		29	10	S5540_002_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											92.12	50	50	50				92.12	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	2	0		29	10	S5540_002_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31											912.4	25						912.4	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	4	0		29	10	S5540_004_0	4	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					3	6	9											15	30	45				3	6	9				15				15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	4	0		29	10	S5540_004_0	4	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					3	6	9											15	30	45				3	6	9				15				15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5540	4	0		29	10	S5540_004_0	4	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					6	12	18											20	40	60				6	12	18				20				20			0.67	0.2		0.67	0.2	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	4	0		29	10	S5540_004_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								45	90	135					30	60	90											45	90	135				30	60	90				45				45			1.5	1		1.5	1	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	4	0		29	10	S5540_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											59.98	50	50	50				59.98	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5540	4	0		29	10	S5540_004_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31											1079	33						1079	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	4	0		29	10	S5552_004_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	4	0		29	10	S5552_004_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	4	0		29	10	S5552_004_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				40	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	4	0		29	10	S5552_004_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				62	33		33																								33		33				33		30			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	4	0		29	10	S5552_004_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	5	0		29	10	S5552_005_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	5	0		29	10	S5552_005_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	5	0		29	10	S5552_005_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	5	0		29	10	S5552_005_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											89	50		50				54	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	5	0		29	10	S5552_005_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	6	0		29	10	S5552_006_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	6	0		29	10	S5552_006_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	6	0		29	10	S5552_006_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	6	0		29	10	S5552_006_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											92	50		50				64	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5552	6	0		29	10	S5552_006_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	1	0		29	10	S5584_001_0	5	Preferred Generic	3	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	1	0		29	10	S5584_001_0	5	Generic	3	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	1	0		29	10	S5584_001_0	5	Preferred Brand	3	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	1	0		29	10	S5584_001_0	5	Non-Preferred Drug	3	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											40	50		50				40	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	1	0		29	10	S5584_001_0	5	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											1	28						1	28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	2	0		29	10	S5584_002_0	5	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								6		18					1		3											6		18				1		3				6				6			0.19	0.03		0.19	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	2	0		29	10	S5584_002_0	5	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								10		30					5		15											10		30				5		15				10				10			0.32	0.16		0.32	0.16	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	2	0		29	10	S5584_002_0	5	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								45		135					40		120											45		135				40		120				45				45			1.45	1.29		1.45	1.29	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	2	0		29	10	S5584_002_0	5	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											48	45		45				53	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	2	0		29	10	S5584_002_0	5	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	33						1	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	5	0		29	10	S5584_005_0	6	Preferred Generic	4	1	1	2	1	1		110	1		110	1				31		90	1	2				31		90	31		31								8		24					2		6											8		24				2		6				8				8			0.26	0.06		0.26	0.06	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	5	0		29	10	S5584_005_0	6	Generic	4	1	1	2	2	1		110	1		110	1				31		90	1	2				31		90	31		31								20		60					11		33											20		60				11		33				20				20			0.65	0.35		0.65	0.35	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	5	0		29	10	S5584_005_0	6	Preferred Brand	4	10	1	2	3	1		110	1		110	1				31		90	1	2				31		90	31		31								47		141					42		126											47		141				42		126				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	5	0		29	10	S5584_005_0	6	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				31		90	1	2				31		90	31		31											69	50		50				68	50		50										50		50				50		50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5584	5	0		29	10	S5584_005_0	6	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1	32						1	32												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	2	0		29	10	S5593_002_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								4		12					0		0													10						0				4				4			0.13	0				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	2	0		29	10	S5593_002_0	2	Generic	2	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								12		36					7		21													30						17.5				12				12			0.39	0.23				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	2	0		29	10	S5593_002_0	2	Preferred Brand	2	11	1	1	3	1		110	1		100	1				31		90	1	2						90	31		31											40.91	25		25				40.91	20		20												25						20			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	2	0		29	10	S5593_002_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				31		90	1	2						90	31		31											74.69	50		50				74.69	40		40												50						40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	2	0		29	10	S5593_002_0	2	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											1058.04	25						1058.04	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	3	0		29	10	S5593_003_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				31		90	1	2						90	31		31								4		12					0		0													10						0				4				4			0.13	0				0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	3	0		29	10	S5593_003_0	2	Preferred Generic	4	1	1	1	1	3		110	1		100	1				31		90	1	2						90	31		31											1.32	15		15				1.32	10		10												15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5593	3	0		29	10	S5593_003_0	2	Generic	4	1	1	2	2	1		110	1		100	1				31		90	1	2						90	31		31								10		30					5		15													25						12.5				10				10			0.32	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	3	0		29	10	S5593_003_0	2	Generic	4	1	1	1	2	3		110	1		100	1				31		90	1	2						90	31		31											4.92	15		15				4.92	10		10												15						10			15			15								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5593	3	0		29	10	S5593_003_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				31		90	1	2						90	31		31								45		135					40		120													112.5						100				45				45			1.45	1.29				1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	3	0		29	10	S5593_003_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				31		90	1	2						90	31		31											72.91	50		50				72.91	35		35												50						35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5593	3	0		29	10	S5593_003_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											1332.27	33						1332.27	33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	1	0		29	10	S5596_001_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	1	0		29	10	S5596_001_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	1	0		29	10	S5596_001_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	1	0		29	10	S5596_001_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	1	0		29	10	S5596_001_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											74.47	50	50	50				62.55	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	1	0		29	10	S5596_001_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	5	0		29	10	S5596_005_0	4	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					1	2	3					1	2	3																11				11			0.37	0.03	0.03			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	5	0		29	10	S5596_005_0	4	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					2	4	6					2	4	6																12				12			0.4	0.07	0.07			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	5	0		29	10	S5596_005_0	4	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								43	86	129					33	66	99					33	66	99																43				43			1.43	1.1	1.1			1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	5	0		29	10	S5596_005_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											84.04	50	50	50				67.23	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	5	0		29	10	S5596_005_0	4	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	6	0		29	10	S5596_006_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	6	0		29	10	S5596_006_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	6	0		29	10	S5596_006_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	6	0		29	10	S5596_006_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	6	0		29	10	S5596_006_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											64.89	50	50	50				54.51	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	6	0		29	10	S5596_006_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	9	0		29	10	S5596_009_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					1	2	3					1	2	3																11				11			0.37	0.03	0.03			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	9	0		29	10	S5596_009_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					3	6	9					3	6	9																13				13			0.43	0.1	0.1			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	9	0		29	10	S5596_009_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					32	64	96					32	64	96																42				42			1.4	1.07	1.07			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	9	0		29	10	S5596_009_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											88.77	50	50	50				71.01	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	9	0		29	10	S5596_009_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	10	0		29	10	S5596_010_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	10	0		29	10	S5596_010_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	10	0		29	10	S5596_010_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	10	0		29	10	S5596_010_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	10	0		29	10	S5596_010_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											69.31	50	50	50				58.22	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	10	0		29	10	S5596_010_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	13	0		29	10	S5596_013_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					1	2	3					1	2	3																10				10			0.33	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	13	0		29	10	S5596_013_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								11	22	33					2	4	6					2	4	6																11				11			0.37	0.07	0.07			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	13	0		29	10	S5596_013_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					32	64	96					32	64	96																42				42			1.4	1.07	1.07			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	13	0		29	10	S5596_013_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											86.23	50	50	50				68.99	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	13	0		29	10	S5596_013_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	14	0		29	10	S5596_014_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	14	0		29	10	S5596_014_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	14	0		29	10	S5596_014_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	14	0		29	10	S5596_014_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	14	0		29	10	S5596_014_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											66.75	50	50	50				56.07	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	14	0		29	10	S5596_014_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	17	0		29	10	S5596_017_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					1	2	3					1	2	3																11				11			0.37	0.03	0.03			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	17	0		29	10	S5596_017_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					3	6	9					3	6	9																13				13			0.43	0.1	0.1			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	17	0		29	10	S5596_017_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					32	64	96					32	64	96																42				42			1.4	1.07	1.07			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	17	0		29	10	S5596_017_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											81.87	50	50	50				65.49	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	17	0		29	10	S5596_017_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	18	0		29	10	S5596_018_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	18	0		29	10	S5596_018_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	18	0		29	10	S5596_018_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	18	0		29	10	S5596_018_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	18	0		29	10	S5596_018_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											62.34	50	50	50				52.37	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	18	0		29	10	S5596_018_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	33	0		29	10	S5596_033_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					1	2	3					1	2	3																10				10			0.33	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	33	0		29	10	S5596_033_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								11	22	33					2	4	6					2	4	6																11				11			0.37	0.07	0.07			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	33	0		29	10	S5596_033_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								43	86	129					33	66	99					33	66	99																43				43			1.43	1.1	1.1			1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	33	0		29	10	S5596_033_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											109.85	50	50	50				87.88	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	33	0		29	10	S5596_033_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	34	0		29	10	S5596_034_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	34	0		29	10	S5596_034_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	34	0		29	10	S5596_034_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	34	0		29	10	S5596_034_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	34	0		29	10	S5596_034_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											81.03	50	50	50				68.07	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	34	0		29	10	S5596_034_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	43	0		29	10	S5596_043_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					1	2	3					1	2	3																10				10			0.33	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	43	0		29	10	S5596_043_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					3	6	9					3	6	9																12				12			0.4	0.1	0.1			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	43	0		29	10	S5596_043_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								41	82	123					31	62	93					31	62	93																41				41			1.37	1.03	1.03			1.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	43	0		29	10	S5596_043_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											82.43	50	50	50				65.94	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	43	0		29	10	S5596_043_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	44	0		29	10	S5596_044_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	44	0		29	10	S5596_044_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	44	0		29	10	S5596_044_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	44	0		29	10	S5596_044_0	3	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	44	0		29	10	S5596_044_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											65.71	50	50	50				55.2	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	44	0		29	10	S5596_044_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	46	0		29	10	S5596_046_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					1	2	3					1	2	3																11				11			0.37	0.03	0.03			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	46	0		29	10	S5596_046_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					3	6	9					3	6	9																12				12			0.4	0.1	0.1			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	46	0		29	10	S5596_046_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					32	64	96					32	64	96																42				42			1.4	1.07	1.07			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	46	0		29	10	S5596_046_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											99.07	50	50	50				79.26	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	46	0		29	10	S5596_046_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	56	0		29	10	S5596_056_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								6	12	18					1	2	3					1	2	3																6				6			0.2	0.03	0.03			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	56	0		29	10	S5596_056_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								8	16	24					3	6	9					3	6	9																8				8			0.27	0.1	0.1			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	56	0		29	10	S5596_056_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								40	80	120					30	60	90					30	60	90																40				40			1.33	1	1			1.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	56	0		29	10	S5596_056_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											76.65	44	44	44				67.94	39	39	39				39	39	39															44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	56	0		29	10	S5596_056_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	57	0		29	10	S5596_057_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	57	0		29	10	S5596_057_0	5	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	57	0		29	10	S5596_057_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	57	0		29	10	S5596_057_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	57	0		29	10	S5596_057_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											61.57	50	50	50				51.72	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	57	0		29	10	S5596_057_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	59	0		29	10	S5596_059_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					1	2	3					1	2	3																11				11			0.37	0.03	0.03			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	59	0		29	10	S5596_059_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					3	6	9					3	6	9																13				13			0.43	0.1	0.1			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	59	0		29	10	S5596_059_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					32	64	96					32	64	96																42				42			1.4	1.07	1.07			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	59	0		29	10	S5596_059_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											89.62	50	50	50				73.49	41	41	41				41	41	41															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	59	0		29	10	S5596_059_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	60	0		29	10	S5596_060_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	60	0		29	10	S5596_060_0	5	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	60	0		29	10	S5596_060_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	60	0		29	10	S5596_060_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	60	0		29	10	S5596_060_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											77.72	50	50	50				65.29	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	60	0		29	10	S5596_060_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	62	0		29	10	S5596_062_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								10	20	30					1	2	3					1	2	3																10				10			0.33	0.03	0.03			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	62	0		29	10	S5596_062_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								12	24	36					3	6	9					3	6	9																12				12			0.4	0.1	0.1			0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	62	0		29	10	S5596_062_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								44	88	132					34	68	102					34	68	102																44				44			1.47	1.13	1.13			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	62	0		29	10	S5596_062_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											92.79	50	50	50				74.23	40	40	40				40	40	40															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	62	0		29	10	S5596_062_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	63	0		29	10	S5596_063_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	63	0		29	10	S5596_063_0	5	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	63	0		29	10	S5596_063_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	63	0		29	10	S5596_063_0	5	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	63	0		29	10	S5596_063_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											67.34	50	50	50				56.57	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	63	0		29	10	S5596_063_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	66	0		29	10	S5596_066_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	66	0		29	10	S5596_066_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	66	0		29	10	S5596_066_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	66	0		29	10	S5596_066_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	66	0		29	10	S5596_066_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											22.37	22	22	22				20.34	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	66	0		29	10	S5596_066_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											62.2	39	39	39				59.01	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	66	0		29	10	S5596_066_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	68	0		29	10	S5596_068_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	68	0		29	10	S5596_068_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	68	0		29	10	S5596_068_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	68	0		29	10	S5596_068_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	68	0		29	10	S5596_068_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											22.71	22	22	22				20.64	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	68	0		29	10	S5596_068_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											65.6	40	40	40				62.32	38	38	38				38	38	38															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	68	0		29	10	S5596_068_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	70	0		29	10	S5596_070_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	70	0		29	10	S5596_070_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	70	0		29	10	S5596_070_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	70	0		29	10	S5596_070_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	70	0		29	10	S5596_070_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											22.28	22	22	22				20.26	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	70	0		29	10	S5596_070_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											62.76	39	39	39				59.54	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	70	0		29	10	S5596_070_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	72	0		29	10	S5596_072_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	72	0		29	10	S5596_072_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	72	0		29	10	S5596_072_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	72	0		29	10	S5596_072_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	72	0		29	10	S5596_072_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											21.68	22	22	22				19.71	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	72	0		29	10	S5596_072_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											60.34	39	39	39				57.25	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	72	0		29	10	S5596_072_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	74	0		29	10	S5596_074_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	74	0		29	10	S5596_074_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	74	0		29	10	S5596_074_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	74	0		29	10	S5596_074_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	74	0		29	10	S5596_074_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											21.61	22	22	22				19.65	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	74	0		29	10	S5596_074_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											60.91	39	39	39				57.78	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	74	0		29	10	S5596_074_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	76	0		29	10	S5596_076_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	76	0		29	10	S5596_076_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	76	0		29	10	S5596_076_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	76	0		29	10	S5596_076_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	76	0		29	10	S5596_076_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											23.99	22	22	22				21.81	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	76	0		29	10	S5596_076_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											66.79	39	39	39				63.37	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	76	0		29	10	S5596_076_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	78	0		29	10	S5596_078_0	5	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	78	0		29	10	S5596_078_0	5	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	78	0		29	10	S5596_078_0	5	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	78	0		29	10	S5596_078_0	5	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	78	0		29	10	S5596_078_0	5	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											21.59	22	22	22				19.63	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	78	0		29	10	S5596_078_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											62.25	40	40	40				59.14	38	38	38				38	38	38															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	78	0		29	10	S5596_078_0	5	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	80	0		29	10	S5596_080_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	80	0		29	10	S5596_080_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	80	0		29	10	S5596_080_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	80	0		29	10	S5596_080_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	80	0		29	10	S5596_080_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											21.35	22	22	22				19.41	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	80	0		29	10	S5596_080_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											59.38	39	39	39				56.34	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	80	0		29	10	S5596_080_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	82	0		29	10	S5596_082_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	82	0		29	10	S5596_082_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								8	16	24					1	2	3					1	2	3																8				8			0.27	0.03	0.03			0.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	82	0		29	10	S5596_082_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	82	0		29	10	S5596_082_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								9	18	27					2	4	6					2	4	6																9				9			0.3	0.07	0.07			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	82	0		29	10	S5596_082_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											23.48	22	22	22				21.35	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	82	0		29	10	S5596_082_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											65.07	39	39	39				61.73	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	82	0		29	10	S5596_082_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	84	0		29	10	S5596_084_0	6	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	84	0		29	10	S5596_084_0	6	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	84	0		29	10	S5596_084_0	6	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	84	0		29	10	S5596_084_0	6	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5596	84	0		29	10	S5596_084_0	6	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											23.06	22	22	22				20.97	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	84	0		29	10	S5596_084_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											64.28	39	39	39				60.99	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5596	84	0		29	10	S5596_084_0	6	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5601	2	0		29	10	S5601_002_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	2	0		29	10	S5601_002_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	2	0		29	10	S5601_002_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	2	0		29	10	S5601_002_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.07	38	38	38				68.97	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	2	0		29	10	S5601_002_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											873.74	26						998.57	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	3	0		29	10	S5601_003_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	3	0		29	10	S5601_003_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	3	0		29	10	S5601_003_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	3	0		29	10	S5601_003_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	3	0		29	10	S5601_003_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	3	0		29	10	S5601_003_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.73	50	50	50				61.73	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	3	0		29	10	S5601_003_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											924.02	33						1302.22	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	4	0		29	10	S5601_004_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	4	0		29	10	S5601_004_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	4	0		29	10	S5601_004_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	4	0		29	10	S5601_004_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.7	38	38	38				76.38	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	4	0		29	10	S5601_004_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											681.54	28						728.28	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	5	0		29	10	S5601_005_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	5	0		29	10	S5601_005_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	5	0		29	10	S5601_005_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	5	0		29	10	S5601_005_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	5	0		29	10	S5601_005_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	5	0		29	10	S5601_005_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.05	50	50	50				75.6	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	5	0		29	10	S5601_005_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1079.19	33						1101.05	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	6	0		29	10	S5601_006_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	6	0		29	10	S5601_006_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	6	0		29	10	S5601_006_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	6	0		29	10	S5601_006_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.9	38	38	38				77.73	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	6	0		29	10	S5601_006_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											710.87	27						763.81	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	7	0		29	10	S5601_007_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	7	0		29	10	S5601_007_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	7	0		29	10	S5601_007_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	7	0		29	10	S5601_007_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	7	0		29	10	S5601_007_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	7	0		29	10	S5601_007_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.26	50	50	50				73.63	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	7	0		29	10	S5601_007_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											823.77	33						928.31	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	8	0		29	10	S5601_008_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	8	0		29	10	S5601_008_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	8	0		29	10	S5601_008_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	8	0		29	10	S5601_008_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.05	38	38	38				76.3	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	8	0		29	10	S5601_008_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											777.86	27						743.31	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	9	0		29	10	S5601_009_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	9	0		29	10	S5601_009_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	9	0		29	10	S5601_009_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	9	0		29	10	S5601_009_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	9	0		29	10	S5601_009_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	9	0		29	10	S5601_009_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.58	47	47	47				61.05	47	47	47										47	47	47				47	47	47				47		47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	9	0		29	10	S5601_009_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1238.95	33						1825	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	10	0		29	10	S5601_010_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	10	0		29	10	S5601_010_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	10	0		29	10	S5601_010_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	10	0		29	10	S5601_010_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.4	38	38	38				67.56	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	10	0		29	10	S5601_010_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											706.56	25						689.51	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	11	0		29	10	S5601_011_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	11	0		29	10	S5601_011_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	11	0		29	10	S5601_011_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	11	0		29	10	S5601_011_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	11	0		29	10	S5601_011_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	11	0		29	10	S5601_011_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.46	50	50	50				67	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	11	0		29	10	S5601_011_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											754.62	33						761.05	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	12	0		29	10	S5601_012_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	12	0		29	10	S5601_012_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	12	0		29	10	S5601_012_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	12	0		29	10	S5601_012_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.99	38	38	38				70.5	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	12	0		29	10	S5601_012_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											736.15	26						677.93	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	13	0		29	10	S5601_013_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	13	0		29	10	S5601_013_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	13	0		29	10	S5601_013_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	13	0		29	10	S5601_013_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	13	0		29	10	S5601_013_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	13	0		29	10	S5601_013_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.52	50	50	50				63.57	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	13	0		29	10	S5601_013_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1141.24	33						1044.63	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	14	0		29	10	S5601_014_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	14	0		29	10	S5601_014_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	14	0		29	10	S5601_014_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	14	0		29	10	S5601_014_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.11	38	38	38				78.4	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	14	0		29	10	S5601_014_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											764.14	25						752.75	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	15	0		29	10	S5601_015_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	15	0		29	10	S5601_015_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	15	0		29	10	S5601_015_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	15	0		29	10	S5601_015_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	15	0		29	10	S5601_015_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	15	0		29	10	S5601_015_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.16	50	50	50				69.65	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	15	0		29	10	S5601_015_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1283.57	33						1211.42	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	16	0		29	10	S5601_016_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	16	0		29	10	S5601_016_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	16	0		29	10	S5601_016_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	16	0		29	10	S5601_016_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80	38	38	38				76.11	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	16	0		29	10	S5601_016_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											724.03	26						742.86	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	17	0		29	10	S5601_017_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	17	0		29	10	S5601_017_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	17	0		29	10	S5601_017_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	17	0		29	10	S5601_017_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	17	0		29	10	S5601_017_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	17	0		29	10	S5601_017_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.77	50	50	50				62.59	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	17	0		29	10	S5601_017_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1150.87	33						1138.36	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	18	0		29	10	S5601_018_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	18	0		29	10	S5601_018_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	18	0		29	10	S5601_018_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	18	0		29	10	S5601_018_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.2	38	38	38				70.64	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	18	0		29	10	S5601_018_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											708.76	25						741.45	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	19	0		29	10	S5601_019_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	19	0		29	10	S5601_019_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	19	0		29	10	S5601_019_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	19	0		29	10	S5601_019_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	19	0		29	10	S5601_019_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	19	0		29	10	S5601_019_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.82	50	50	50				61.44	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	19	0		29	10	S5601_019_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1129.38	33						1155.82	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	20	0		29	10	S5601_020_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	20	0		29	10	S5601_020_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	20	0		29	10	S5601_020_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	20	0		29	10	S5601_020_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.81	38	38	38				68.79	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	20	0		29	10	S5601_020_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											687.35	27						665.48	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	21	0		29	10	S5601_021_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	21	0		29	10	S5601_021_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	21	0		29	10	S5601_021_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	21	0		29	10	S5601_021_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	21	0		29	10	S5601_021_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	21	0		29	10	S5601_021_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.8	50	50	50				64.23	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	21	0		29	10	S5601_021_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											973.62	33						1121.81	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	22	0		29	10	S5601_022_0	3	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	22	0		29	10	S5601_022_0	3	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	22	0		29	10	S5601_022_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	22	0		29	10	S5601_022_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.21	38	38	38				67.79	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	22	0		29	10	S5601_022_0	3	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											681.17	28						639.69	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	23	0		29	10	S5601_023_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	23	0		29	10	S5601_023_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	23	0		29	10	S5601_023_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	23	0		29	10	S5601_023_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	23	0		29	10	S5601_023_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	23	0		29	10	S5601_023_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.47	50	50	50				71.2	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	23	0		29	10	S5601_023_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1024.49	33						1040.17	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	24	0		29	10	S5601_024_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	24	0		29	10	S5601_024_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	24	0		29	10	S5601_024_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	24	0		29	10	S5601_024_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.43	38	38	38				67.32	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	24	0		29	10	S5601_024_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											726.69	26						679.85	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	25	0		29	10	S5601_025_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	25	0		29	10	S5601_025_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	25	0		29	10	S5601_025_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	25	0		29	10	S5601_025_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	25	0		29	10	S5601_025_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	25	0		29	10	S5601_025_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.07	50	50	50				59.58	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	25	0		29	10	S5601_025_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1006.6	33						1117.94	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	26	0		29	10	S5601_026_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	26	0		29	10	S5601_026_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	26	0		29	10	S5601_026_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	26	0		29	10	S5601_026_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.59	38	38	38				76.21	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	26	0		29	10	S5601_026_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											838.04	27						815.8	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	27	0		29	10	S5601_027_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	27	0		29	10	S5601_027_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	27	0		29	10	S5601_027_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	27	0		29	10	S5601_027_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	27	0		29	10	S5601_027_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	27	0		29	10	S5601_027_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.7	50	50	50				60	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	27	0		29	10	S5601_027_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											871.66	33						807.3	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	28	0		29	10	S5601_028_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	28	0		29	10	S5601_028_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	28	0		29	10	S5601_028_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	28	0		29	10	S5601_028_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.65	38	38	38				72.8	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	28	0		29	10	S5601_028_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											828.77	26						881.08	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	29	0		29	10	S5601_029_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	29	0		29	10	S5601_029_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	29	0		29	10	S5601_029_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	29	0		29	10	S5601_029_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	29	0		29	10	S5601_029_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	29	0		29	10	S5601_029_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.65	50	50	50				61	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	29	0		29	10	S5601_029_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1192.82	33						1224.34	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	30	0		29	10	S5601_030_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	30	0		29	10	S5601_030_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	30	0		29	10	S5601_030_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	30	0		29	10	S5601_030_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.83	38	38	38				73.46	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	30	0		29	10	S5601_030_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											625.29	26						643.39	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	31	0		29	10	S5601_031_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	31	0		29	10	S5601_031_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	31	0		29	10	S5601_031_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	31	0		29	10	S5601_031_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	31	0		29	10	S5601_031_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	31	0		29	10	S5601_031_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.88	50	50	50				66.18	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	31	0		29	10	S5601_031_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											971.77	33						928.5	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	32	0		29	10	S5601_032_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	32	0		29	10	S5601_032_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	32	0		29	10	S5601_032_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	32	0		29	10	S5601_032_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.75	38	38	38				67.39	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	32	0		29	10	S5601_032_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											785.83	29						830.41	29												29						29						29		29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	33	0		29	10	S5601_033_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	33	0		29	10	S5601_033_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	33	0		29	10	S5601_033_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	33	0		29	10	S5601_033_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	33	0		29	10	S5601_033_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	33	0		29	10	S5601_033_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.49	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"												1
S5601	33	0		29	10	S5601_033_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1150.13	33						1419.69	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	34	0		29	10	S5601_034_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	34	0		29	10	S5601_034_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	34	0		29	10	S5601_034_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	34	0		29	10	S5601_034_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.43	38	38	38				75.86	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	34	0		29	10	S5601_034_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											860.22	26						853.07	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	35	0		29	10	S5601_035_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	35	0		29	10	S5601_035_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	35	0		29	10	S5601_035_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	35	0		29	10	S5601_035_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	35	0		29	10	S5601_035_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	35	0		29	10	S5601_035_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.43	50	50	50				72.13	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	35	0		29	10	S5601_035_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1213.27	33						1155.52	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	36	0		29	10	S5601_036_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	36	0		29	10	S5601_036_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	36	0		29	10	S5601_036_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	36	0		29	10	S5601_036_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.51	38	38	38				70.22	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	36	0		29	10	S5601_036_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											766.41	27						752.09	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	37	0		29	10	S5601_037_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	37	0		29	10	S5601_037_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	37	0		29	10	S5601_037_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	37	0		29	10	S5601_037_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	37	0		29	10	S5601_037_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	37	0		29	10	S5601_037_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.39	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"												1
S5601	37	0		29	10	S5601_037_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1184.43	33						976.56	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	38	0		29	10	S5601_038_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	38	0		29	10	S5601_038_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	38	0		29	10	S5601_038_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	38	0		29	10	S5601_038_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.67	38	38	38				73.39	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	38	0		29	10	S5601_038_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											743.85	26						701.48	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	40	0		29	10	S5601_040_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	40	0		29	10	S5601_040_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	40	0		29	10	S5601_040_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	40	0		29	10	S5601_040_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.04	38	38	38				69.84	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	40	0		29	10	S5601_040_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											617.81	26						672.78	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	41	0		29	10	S5601_041_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	41	0		29	10	S5601_041_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	41	0		29	10	S5601_041_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	41	0		29	10	S5601_041_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	41	0		29	10	S5601_041_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	41	0		29	10	S5601_041_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.85	50	50	50				60.83	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	41	0		29	10	S5601_041_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											995.13	33						931.91	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	42	0		29	10	S5601_042_0	3	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	42	0		29	10	S5601_042_0	3	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	42	0		29	10	S5601_042_0	3	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	42	0		29	10	S5601_042_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.48	38	38	38				70.79	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	42	0		29	10	S5601_042_0	3	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											605.07	27						574.05	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	44	0		29	10	S5601_044_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	44	0		29	10	S5601_044_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	44	0		29	10	S5601_044_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	44	0		29	10	S5601_044_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.43	38	38	38				71.46	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	44	0		29	10	S5601_044_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											639.2	26						665.52	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	45	0		29	10	S5601_045_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	45	0		29	10	S5601_045_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	45	0		29	10	S5601_045_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	45	0		29	10	S5601_045_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	45	0		29	10	S5601_045_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	45	0		29	10	S5601_045_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.58	50	50	50				66.2	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	45	0		29	10	S5601_045_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1157.42	33						1092.33	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	46	0		29	10	S5601_046_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	46	0		29	10	S5601_046_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	46	0		29	10	S5601_046_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	46	0		29	10	S5601_046_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.54	38	38	38				71.06	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	46	0		29	10	S5601_046_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											816.98	26						777.96	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	48	0		29	10	S5601_048_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	48	0		29	10	S5601_048_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	48	0		29	10	S5601_048_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	48	0		29	10	S5601_048_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.28	38	38	38				69.81	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	48	0		29	10	S5601_048_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											963.38	26						1045.2	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	49	0		29	10	S5601_049_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	49	0		29	10	S5601_049_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	49	0		29	10	S5601_049_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	49	0		29	10	S5601_049_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	49	0		29	10	S5601_049_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	49	0		29	10	S5601_049_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.14	50	50	50				57.92	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	49	0		29	10	S5601_049_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1020.37	33						1298.92	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	50	0		29	10	S5601_050_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	50	0		29	10	S5601_050_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	50	0		29	10	S5601_050_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	50	0		29	10	S5601_050_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.5	38	38	38				70.53	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	50	0		29	10	S5601_050_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											866.19	27						963.2	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	51	0		29	10	S5601_051_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	51	0		29	10	S5601_051_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	51	0		29	10	S5601_051_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	51	0		29	10	S5601_051_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	51	0		29	10	S5601_051_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	51	0		29	10	S5601_051_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.32	50	50	50				64.08	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	51	0		29	10	S5601_051_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1264.69	33						1382.08	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	52	0		29	10	S5601_052_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	52	0		29	10	S5601_052_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	52	0		29	10	S5601_052_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	52	0		29	10	S5601_052_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.67	38	38	38				67.45	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	52	0		29	10	S5601_052_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											838.51	27						918.28	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	53	0		29	10	S5601_053_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	53	0		29	10	S5601_053_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	53	0		29	10	S5601_053_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	53	0		29	10	S5601_053_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	53	0		29	10	S5601_053_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	53	0		29	10	S5601_053_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.52	50	50	50				65.91	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	53	0		29	10	S5601_053_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1131.2	33						1357.95	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	54	0		29	10	S5601_054_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	54	0		29	10	S5601_054_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	54	0		29	10	S5601_054_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	54	0		29	10	S5601_054_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.17	38	38	38				69.56	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	54	0		29	10	S5601_054_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											878.07	26						845.94	26												26						26						26		26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	55	0		29	10	S5601_055_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	55	0		29	10	S5601_055_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	55	0		29	10	S5601_055_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	55	0		29	10	S5601_055_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	55	0		29	10	S5601_055_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	55	0		29	10	S5601_055_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.56	50	50	50				63.71	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	55	0		29	10	S5601_055_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1054.22	33						1449.52	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	56	0		29	10	S5601_056_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	56	0		29	10	S5601_056_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	56	0		29	10	S5601_056_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	56	0		29	10	S5601_056_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.77	38	38	38				75.79	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	56	0		29	10	S5601_056_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											726.53	25						789.89	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	57	0		29	10	S5601_057_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	57	0		29	10	S5601_057_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	57	0		29	10	S5601_057_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	57	0		29	10	S5601_057_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	57	0		29	10	S5601_057_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	57	0		29	10	S5601_057_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.53	49	49	49				62.13	49	49	49										49	49	49				49	49	49				49		49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	57	0		29	10	S5601_057_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1120.26	33						1723.46	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	58	0		29	10	S5601_058_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	58	0		29	10	S5601_058_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	58	0		29	10	S5601_058_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	58	0		29	10	S5601_058_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.76	38	38	38				76.93	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	58	0		29	10	S5601_058_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											729.38	25						787.25	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	59	0		29	10	S5601_059_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	59	0		29	10	S5601_059_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	59	0		29	10	S5601_059_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	59	0		29	10	S5601_059_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	59	0		29	10	S5601_059_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	59	0		29	10	S5601_059_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.49	50	50	50				65.04	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	59	0		29	10	S5601_059_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											993.52	33						1350.48	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	60	0		29	10	S5601_060_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	60	0		29	10	S5601_060_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	60	0		29	10	S5601_060_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	60	0		29	10	S5601_060_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.73	38	38	38				69.33	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	60	0		29	10	S5601_060_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											703.48	28						643.45	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	61	0		29	10	S5601_061_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	61	0		29	10	S5601_061_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	61	0		29	10	S5601_061_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	61	0		29	10	S5601_061_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	61	0		29	10	S5601_061_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	61	0		29	10	S5601_061_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.67	50	50	50				59.72	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	61	0		29	10	S5601_061_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											729.32	33						865.99	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	62	0		29	10	S5601_062_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	62	0		29	10	S5601_062_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	62	0		29	10	S5601_062_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	62	0		29	10	S5601_062_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.83	38	38	38				76.58	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	62	0		29	10	S5601_062_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											861.98	27						661.41	27												27						27						27		27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	63	0		29	10	S5601_063_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	63	0		29	10	S5601_063_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	63	0		29	10	S5601_063_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	63	0		29	10	S5601_063_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	63	0		29	10	S5601_063_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	63	0		29	10	S5601_063_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.97	50	50	50				61.32	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	63	0		29	10	S5601_063_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1057.03	33						1412.64	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	64	0		29	10	S5601_064_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	64	0		29	10	S5601_064_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	64	0		29	10	S5601_064_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	64	0		29	10	S5601_064_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.38	38	38	38				79.03	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	64	0		29	10	S5601_064_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											664.75	28						835.91	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	65	0		29	10	S5601_065_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	65	0		29	10	S5601_065_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	65	0		29	10	S5601_065_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	65	0		29	10	S5601_065_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	65	0		29	10	S5601_065_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	65	0		29	10	S5601_065_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.69	49	49	49				66.01	49	49	49										49	49	49				49	49	49				49		49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	65	0		29	10	S5601_065_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											891.76	33						858.01	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	66	0		29	10	S5601_066_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	66	0		29	10	S5601_066_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8	16	24					1	2	3											8	16	24				1	2	3					8			8			0.27	0.03		0.27	0.03	0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	66	0		29	10	S5601_066_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	66	0		29	10	S5601_066_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.28	35	35	35				84.77	35	35	35										35	35	35				35	35	35				35		35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	66	0		29	10	S5601_066_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											678.27	25						620.15	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	67	0		29	10	S5601_067_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	67	0		29	10	S5601_067_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	67	0		29	10	S5601_067_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	67	0		29	10	S5601_067_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	67	0		29	10	S5601_067_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	67	0		29	10	S5601_067_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.28	49	49	49				60.45	49	49	49										49	49	49				49	49	49				49		49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	67	0		29	10	S5601_067_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											906.14	33						1237.65	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	68	0		29	10	S5601_068_0	2	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	68	0		29	10	S5601_068_0	2	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								6	12	18					1	2	3											6	12	18				1	2	3					6			6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	68	0		29	10	S5601_068_0	2	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	68	0		29	10	S5601_068_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.68	38	38	38				65.89	38	38	38										38	38	38				38	38	38				38		38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	68	0		29	10	S5601_068_0	2	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											790.75	28						826.92	28												28						28						28		28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	107	0		29	10	S5601_107_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	107	0		29	10	S5601_107_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	107	0		29	10	S5601_107_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	107	0		29	10	S5601_107_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	107	0		29	10	S5601_107_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	107	0		29	10	S5601_107_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.26	50	50	50				62.12	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	107	0		29	10	S5601_107_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1083.46	33						1293.4	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	108	0		29	10	S5601_108_0	3	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	108	0		29	10	S5601_108_0	3	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	108	0		29	10	S5601_108_0	3	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	108	0		29	10	S5601_108_0	3	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	108	0		29	10	S5601_108_0	3	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	108	0		29	10	S5601_108_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.35	50	50	50				64.17	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	108	0		29	10	S5601_108_0	3	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											1023.15	33						1349.77	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	109	0		29	10	S5601_109_0	4	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	109	0		29	10	S5601_109_0	4	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5	10	15					0	0	0											5	10	15				0	0	0					5			5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	109	0		29	10	S5601_109_0	4	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	109	0		29	10	S5601_109_0	4	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					2	4	6											10	20	30				2	4	6					10			10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5601	109	0		29	10	S5601_109_0	4	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					47	94	141											47	94	141				47	94	141					47			47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	109	0		29	10	S5601_109_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.32	50	50	50				60.85	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5601	109	0		29	10	S5601_109_0	4	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											971.93	33						1149.89	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												1
S5609	1	0		29	10	S5609_001_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	1	0		29	10	S5609_001_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	34					10	20	20					10	20	20																17				17			0.57	0.33	0.33			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	1	0		29	10	S5609_001_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	1	0		29	10	S5609_001_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	1	0		29	10	S5609_001_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	2	0		29	10	S5609_002_0	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	6																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	2	0		29	10	S5609_002_0	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	6																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5609	2	0		29	10	S5609_002_0	8	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	20																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	2	0		29	10	S5609_002_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	117.5																			47	94	117.5																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	2	0		29	10	S5609_002_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				71.54	40	40	40																		40	40	40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	2	0		29	10	S5609_002_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				853.32	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	3	0		29	10	S5609_003_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	3	0		29	10	S5609_003_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	34					10	20	20					10	20	20																17				17			0.57	0.33	0.33			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	3	0		29	10	S5609_003_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	3	0		29	10	S5609_003_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											80.48	45	45	45				71.54	40	40	40				40	40	40															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5609	3	0		29	10	S5609_003_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	3	0		29	10	S5617_003_0	2	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	3	0		29	10	S5617_003_0	2	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	3	0		29	10	S5617_003_0	2	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	3	0		29	10	S5617_003_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											57.78	38	38	38				52.44	37	37	37										38	38	38				37	37	37			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	3	0		29	10	S5617_003_0	2	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	3	0		29	10	S5617_003_0	2	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	8	0		29	10	S5617_008_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	8	0		29	10	S5617_008_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	8	0		29	10	S5617_008_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								30	60	90					30	60	90											30	60	90				30	60	90				30				30			1	1		1	1	0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	8	0		29	10	S5617_008_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											58.95	35	35	35				55.5	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	8	0		29	10	S5617_008_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	8	0		29	10	S5617_008_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	13	0		29	10	S5617_013_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	13	0		29	10	S5617_013_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	13	0		29	10	S5617_013_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								31	62	93					30	60	90											31	62	93				30	60	90				31				31			1.03	1		1.03	1	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	13	0		29	10	S5617_013_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											61.03	35	35	35				58.56	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	13	0		29	10	S5617_013_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	13	0		29	10	S5617_013_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	18	0		29	10	S5617_018_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	18	0		29	10	S5617_018_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	18	0		29	10	S5617_018_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								30	60	90					30	60	90											30	60	90				30	60	90				30				30			1	1		1	1	0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	18	0		29	10	S5617_018_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											68.5	34	34	34				57.47	34	34	34										34	34	34				34	34	34			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	18	0		29	10	S5617_018_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	18	0		29	10	S5617_018_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	53	0		29	10	S5617_053_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	53	0		29	10	S5617_053_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	53	0		29	10	S5617_053_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								26	52	78					24	48	72											26	52	78				24	48	72				26				26			0.87	0.8		0.87	0.8	0.84	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	53	0		29	10	S5617_053_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											70.58	40	40	40				59.86	39	39	39										40	40	40				39	39	39			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	53	0		29	10	S5617_053_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	53	0		29	10	S5617_053_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	68	0		29	10	S5617_068_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	68	0		29	10	S5617_068_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	68	0		29	10	S5617_068_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	68	0		29	10	S5617_068_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											66.94	40	40	40				55.16	37	37	37										40	40	40				37	37	37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	68	0		29	10	S5617_068_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	68	0		29	10	S5617_068_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	88	0		29	10	S5617_088_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	88	0		29	10	S5617_088_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	88	0		29	10	S5617_088_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	88	0		29	10	S5617_088_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											54.74	37	37	37				45.3	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	88	0		29	10	S5617_088_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	88	0		29	10	S5617_088_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	103	0		29	10	S5617_103_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	103	0		29	10	S5617_103_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	103	0		29	10	S5617_103_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								30	60	90					30	60	90											30	60	90				30	60	90				30				30			1	1		1	1	0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	103	0		29	10	S5617_103_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											50.7	34	34	34				49.2	34	34	34										34	34	34				34	34	34			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	103	0		29	10	S5617_103_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	103	0		29	10	S5617_103_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	108	0		29	10	S5617_108_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	108	0		29	10	S5617_108_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	108	0		29	10	S5617_108_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								28	56	84					26	52	78											28	56	84				26	52	78				28				28			0.93	0.87		0.93	0.87	0.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	108	0		29	10	S5617_108_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											77.72	36	36	36				62.26	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	108	0		29	10	S5617_108_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	108	0		29	10	S5617_108_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	113	0		29	10	S5617_113_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	113	0		29	10	S5617_113_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	113	0		29	10	S5617_113_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	113	0		29	10	S5617_113_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											61.92	33	33	33				46.97	33	33	33										33	33	33				33	33	33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	113	0		29	10	S5617_113_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	113	0		29	10	S5617_113_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	118	0		29	10	S5617_118_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	118	0		29	10	S5617_118_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	118	0		29	10	S5617_118_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								30	60	90					29	58	87											30	60	90				29	58	87				30				30			1	0.97		1	0.97	0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	118	0		29	10	S5617_118_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											48.76	36	36	36				42.11	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	118	0		29	10	S5617_118_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	118	0		29	10	S5617_118_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	123	0		29	10	S5617_123_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	123	0		29	10	S5617_123_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	123	0		29	10	S5617_123_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	123	0		29	10	S5617_123_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											55.81	34	34	34				49.65	33	33	33										34	34	34				33	33	33			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	123	0		29	10	S5617_123_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	123	0		29	10	S5617_123_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	128	0		29	10	S5617_128_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	128	0		29	10	S5617_128_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	128	0		29	10	S5617_128_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	128	0		29	10	S5617_128_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											71.91	40	40	40				58.49	37	37	37										40	40	40				37	37	37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	128	0		29	10	S5617_128_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	128	0		29	10	S5617_128_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	133	0		29	10	S5617_133_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	133	0		29	10	S5617_133_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	133	0		29	10	S5617_133_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	133	0		29	10	S5617_133_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											63.85	37	37	37				52.95	35	35	35										37	37	37				35	35	35			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	133	0		29	10	S5617_133_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	133	0		29	10	S5617_133_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	138	0		29	10	S5617_138_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	138	0		29	10	S5617_138_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	138	0		29	10	S5617_138_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	138	0		29	10	S5617_138_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											71.41	40	40	40				55.63	38	38	38										40	40	40				38	38	38			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	138	0		29	10	S5617_138_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	138	0		29	10	S5617_138_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	143	0		29	10	S5617_143_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	143	0		29	10	S5617_143_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	143	0		29	10	S5617_143_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	143	0		29	10	S5617_143_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											58.15	35	35	35				49.89	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	143	0		29	10	S5617_143_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	143	0		29	10	S5617_143_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	148	0		29	10	S5617_148_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	148	0		29	10	S5617_148_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	148	0		29	10	S5617_148_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	148	0		29	10	S5617_148_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											58.64	35	35	35				49.54	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	148	0		29	10	S5617_148_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	148	0		29	10	S5617_148_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	153	0		29	10	S5617_153_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	153	0		29	10	S5617_153_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	153	0		29	10	S5617_153_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	153	0		29	10	S5617_153_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											58.77	36	36	36				49.21	35	35	35										36	36	36				35	35	35			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	153	0		29	10	S5617_153_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	153	0		29	10	S5617_153_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	158	0		29	10	S5617_158_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	158	0		29	10	S5617_158_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	158	0		29	10	S5617_158_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	158	0		29	10	S5617_158_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											65.2	34	34	34				59.11	33	33	33										34	34	34				33	33	33			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	158	0		29	10	S5617_158_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	158	0		29	10	S5617_158_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	163	0		29	10	S5617_163_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	163	0		29	10	S5617_163_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	163	0		29	10	S5617_163_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	163	0		29	10	S5617_163_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											85.35	40	40	40				67.98	38	38	38										40	40	40				38	38	38			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	163	0		29	10	S5617_163_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	163	0		29	10	S5617_163_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	214	0		29	10	S5617_214_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	214	0		29	10	S5617_214_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	214	0		29	10	S5617_214_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	214	0		29	10	S5617_214_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											83.13	41	41	41				59	37	37	37										41	41	41				37	37	37			41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	214	0		29	10	S5617_214_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	214	0		29	10	S5617_214_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	215	0		29	10	S5617_215_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	215	0		29	10	S5617_215_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	215	0		29	10	S5617_215_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	215	0		29	10	S5617_215_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											64.67	38	38	38				51.18	38	38	38										38	38	38				38	38	38			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	215	0		29	10	S5617_215_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	215	0		29	10	S5617_215_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	216	0		29	10	S5617_216_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	216	0		29	10	S5617_216_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	216	0		29	10	S5617_216_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	216	0		29	10	S5617_216_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											68.57	39	39	39				59.89	37	37	37										39	39	39				37	37	37			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	216	0		29	10	S5617_216_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	216	0		29	10	S5617_216_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	217	0		29	10	S5617_217_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	217	0		29	10	S5617_217_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	217	0		29	10	S5617_217_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	217	0		29	10	S5617_217_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											58.19	36	36	36				55.3	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	217	0		29	10	S5617_217_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	217	0		29	10	S5617_217_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	218	0		29	10	S5617_218_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	218	0		29	10	S5617_218_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	218	0		29	10	S5617_218_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	218	0		29	10	S5617_218_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											65.73	39	39	39				58.51	38	38	38										39	39	39				38	38	38			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	218	0		29	10	S5617_218_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	218	0		29	10	S5617_218_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	219	0		29	10	S5617_219_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	219	0		29	10	S5617_219_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	219	0		29	10	S5617_219_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								28	56	84					26	52	78											28	56	84				26	52	78				28				28			0.93	0.87		0.93	0.87	0.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	219	0		29	10	S5617_219_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											58.14	36	36	36				51.44	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	219	0		29	10	S5617_219_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	219	0		29	10	S5617_219_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	220	0		29	10	S5617_220_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	220	0		29	10	S5617_220_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	220	0		29	10	S5617_220_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	220	0		29	10	S5617_220_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											75.64	39	39	39				56	37	37	37										39	39	39				37	37	37			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	220	0		29	10	S5617_220_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	220	0		29	10	S5617_220_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	221	0		29	10	S5617_221_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	221	0		29	10	S5617_221_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	221	0		29	10	S5617_221_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	221	0		29	10	S5617_221_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											71.78	37	37	37				55.48	36	36	36										37	37	37				36	36	36			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	221	0		29	10	S5617_221_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	221	0		29	10	S5617_221_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	222	0		29	10	S5617_222_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	222	0		29	10	S5617_222_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	222	0		29	10	S5617_222_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	222	0		29	10	S5617_222_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											73.36	40	40	40				55.34	36	36	36										40	40	40				36	36	36			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	222	0		29	10	S5617_222_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	222	0		29	10	S5617_222_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	223	0		29	10	S5617_223_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	223	0		29	10	S5617_223_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	223	0		29	10	S5617_223_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	223	0		29	10	S5617_223_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											77.5	42	42	42				53.68	37	37	37										42	42	42				37	37	37			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	223	0		29	10	S5617_223_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	223	0		29	10	S5617_223_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	224	0		29	10	S5617_224_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	224	0		29	10	S5617_224_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	224	0		29	10	S5617_224_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	224	0		29	10	S5617_224_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											63.45	41	41	41				54.75	36	36	36										41	41	41				36	36	36			41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	224	0		29	10	S5617_224_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	224	0		29	10	S5617_224_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	225	0		29	10	S5617_225_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	225	0		29	10	S5617_225_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	225	0		29	10	S5617_225_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								33	66	99					30	60	90											33	66	99				30	60	90				33				33			1.1	1		1.1	1	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	225	0		29	10	S5617_225_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											51.74	36	36	36				43.37	34	34	34										36	36	36				34	34	34			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	225	0		29	10	S5617_225_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	225	0		29	10	S5617_225_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	226	0		29	10	S5617_226_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	226	0		29	10	S5617_226_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	226	0		29	10	S5617_226_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	226	0		29	10	S5617_226_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											50.28	37	37	37				47.1	36	36	36										37	37	37				36	36	36			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	226	0		29	10	S5617_226_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	226	0		29	10	S5617_226_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	227	0		29	10	S5617_227_0	1	Preferred Generic	2	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					1	2	3											6	12	18				1	2	0				6				6			0.2	0.03		0.2	0.03	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	227	0		29	10	S5617_227_0	1	Generic	2	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								7	14	21					2	4	6											7	14	21				2	4	6				7				7			0.23	0.07		0.23	0.07	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	227	0		29	10	S5617_227_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								32	64	96					30	60	90											32	64	96				30	60	90				32				32			1.07	1		1.07	1	1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	227	0		29	10	S5617_227_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											68.12	39	39	39				54.45	37	37	37										39	39	39				37	37	37			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	227	0		29	10	S5617_227_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	227	0		29	10	S5617_227_0	1	Select Care Drugs	2	1	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					0	0	0											5	10	15				0	0	0				5				5			0.17	0		0.17	0	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	246	0		29	10	S5617_246_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	246	0		29	10	S5617_246_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	246	0		29	10	S5617_246_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	246	0		29	10	S5617_246_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	246	0		29	10	S5617_246_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	246	0		29	10	S5617_246_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.61	50	50	50				67.35	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	246	0		29	10	S5617_246_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	246	0		29	10	S5617_246_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	247	0		29	10	S5617_247_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	247	0		29	10	S5617_247_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	247	0		29	10	S5617_247_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	247	0		29	10	S5617_247_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	247	0		29	10	S5617_247_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	247	0		29	10	S5617_247_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											88.61	50	50	50				65.73	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	247	0		29	10	S5617_247_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	247	0		29	10	S5617_247_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	248	0		29	10	S5617_248_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	248	0		29	10	S5617_248_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	248	0		29	10	S5617_248_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	248	0		29	10	S5617_248_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	248	0		29	10	S5617_248_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	248	0		29	10	S5617_248_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.43	50	50	50				68.27	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	248	0		29	10	S5617_248_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	248	0		29	10	S5617_248_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	249	0		29	10	S5617_249_0	2	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	249	0		29	10	S5617_249_0	2	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	249	0		29	10	S5617_249_0	2	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	249	0		29	10	S5617_249_0	2	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	249	0		29	10	S5617_249_0	2	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	249	0		29	10	S5617_249_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											81.76	50	50	50				69.14	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	249	0		29	10	S5617_249_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	249	0		29	10	S5617_249_0	2	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	250	0		29	10	S5617_250_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	250	0		29	10	S5617_250_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	250	0		29	10	S5617_250_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	250	0		29	10	S5617_250_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	250	0		29	10	S5617_250_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	250	0		29	10	S5617_250_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.71	50	50	50				63.01	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	250	0		29	10	S5617_250_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	250	0		29	10	S5617_250_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	251	0		29	10	S5617_251_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	251	0		29	10	S5617_251_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	251	0		29	10	S5617_251_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	251	0		29	10	S5617_251_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	251	0		29	10	S5617_251_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	251	0		29	10	S5617_251_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											81.79	50	50	50				59.62	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	251	0		29	10	S5617_251_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	251	0		29	10	S5617_251_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	252	0		29	10	S5617_252_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	252	0		29	10	S5617_252_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	252	0		29	10	S5617_252_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	252	0		29	10	S5617_252_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	252	0		29	10	S5617_252_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	252	0		29	10	S5617_252_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											99.49	49	49	49				71.45	49	49	49										49	49	49				49	49	49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	252	0		29	10	S5617_252_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	252	0		29	10	S5617_252_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	253	0		29	10	S5617_253_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	253	0		29	10	S5617_253_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	253	0		29	10	S5617_253_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	253	0		29	10	S5617_253_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	253	0		29	10	S5617_253_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	253	0		29	10	S5617_253_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											85.71	50	50	50				63.93	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	253	0		29	10	S5617_253_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	253	0		29	10	S5617_253_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	254	0		29	10	S5617_254_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	254	0		29	10	S5617_254_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	254	0		29	10	S5617_254_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	254	0		29	10	S5617_254_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	254	0		29	10	S5617_254_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	254	0		29	10	S5617_254_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											80.23	50	50	50				55.35	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	254	0		29	10	S5617_254_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	254	0		29	10	S5617_254_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	255	0		29	10	S5617_255_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	255	0		29	10	S5617_255_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	255	0		29	10	S5617_255_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	255	0		29	10	S5617_255_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	255	0		29	10	S5617_255_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	255	0		29	10	S5617_255_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											81.83	50	50	50				64.99	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	255	0		29	10	S5617_255_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	255	0		29	10	S5617_255_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	256	0		29	10	S5617_256_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	256	0		29	10	S5617_256_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	256	0		29	10	S5617_256_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	256	0		29	10	S5617_256_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	256	0		29	10	S5617_256_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	256	0		29	10	S5617_256_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											75.39	50	50	50				69.07	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	256	0		29	10	S5617_256_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	256	0		29	10	S5617_256_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	257	0		29	10	S5617_257_0	2	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	257	0		29	10	S5617_257_0	2	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	257	0		29	10	S5617_257_0	2	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	257	0		29	10	S5617_257_0	2	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	257	0		29	10	S5617_257_0	2	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	257	0		29	10	S5617_257_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											70.69	50	50	50				63.96	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	257	0		29	10	S5617_257_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	257	0		29	10	S5617_257_0	2	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	258	0		29	10	S5617_258_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	258	0		29	10	S5617_258_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	258	0		29	10	S5617_258_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	258	0		29	10	S5617_258_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	258	0		29	10	S5617_258_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	258	0		29	10	S5617_258_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											99.9	50	50	50				68.87	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	258	0		29	10	S5617_258_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	258	0		29	10	S5617_258_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	259	0		29	10	S5617_259_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	259	0		29	10	S5617_259_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	259	0		29	10	S5617_259_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	259	0		29	10	S5617_259_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	259	0		29	10	S5617_259_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	259	0		29	10	S5617_259_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											76.84	50	50	50				65.02	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	259	0		29	10	S5617_259_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	259	0		29	10	S5617_259_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	260	0		29	10	S5617_260_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	260	0		29	10	S5617_260_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	260	0		29	10	S5617_260_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	260	0		29	10	S5617_260_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	260	0		29	10	S5617_260_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	260	0		29	10	S5617_260_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											74.47	50	50	50				63.17	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	260	0		29	10	S5617_260_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	260	0		29	10	S5617_260_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	261	0		29	10	S5617_261_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	261	0		29	10	S5617_261_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	261	0		29	10	S5617_261_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	261	0		29	10	S5617_261_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	261	0		29	10	S5617_261_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	261	0		29	10	S5617_261_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.3	50	50	50				71.12	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	261	0		29	10	S5617_261_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	261	0		29	10	S5617_261_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	262	0		29	10	S5617_262_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	262	0		29	10	S5617_262_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	262	0		29	10	S5617_262_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	262	0		29	10	S5617_262_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	262	0		29	10	S5617_262_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	262	0		29	10	S5617_262_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											93.97	50	50	50				69.41	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	262	0		29	10	S5617_262_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	262	0		29	10	S5617_262_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	263	0		29	10	S5617_263_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	263	0		29	10	S5617_263_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	263	0		29	10	S5617_263_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	263	0		29	10	S5617_263_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	263	0		29	10	S5617_263_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	263	0		29	10	S5617_263_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											89.64	50	50	50				68.59	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	263	0		29	10	S5617_263_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	263	0		29	10	S5617_263_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	264	0		29	10	S5617_264_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	264	0		29	10	S5617_264_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	264	0		29	10	S5617_264_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	264	0		29	10	S5617_264_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	264	0		29	10	S5617_264_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	264	0		29	10	S5617_264_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											91.4	50	50	50				65.28	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	264	0		29	10	S5617_264_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	264	0		29	10	S5617_264_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	265	0		29	10	S5617_265_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	265	0		29	10	S5617_265_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	265	0		29	10	S5617_265_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	265	0		29	10	S5617_265_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	265	0		29	10	S5617_265_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	265	0		29	10	S5617_265_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											86.13	50	50	50				63.22	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	265	0		29	10	S5617_265_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	265	0		29	10	S5617_265_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	266	0		29	10	S5617_266_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	266	0		29	10	S5617_266_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	266	0		29	10	S5617_266_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	266	0		29	10	S5617_266_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	266	0		29	10	S5617_266_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	266	0		29	10	S5617_266_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											78.59	50	50	50				60.25	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	266	0		29	10	S5617_266_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	266	0		29	10	S5617_266_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	267	0		29	10	S5617_267_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	267	0		29	10	S5617_267_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	267	0		29	10	S5617_267_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	267	0		29	10	S5617_267_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	267	0		29	10	S5617_267_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	267	0		29	10	S5617_267_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.13	50	50	50				72.92	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	267	0		29	10	S5617_267_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	267	0		29	10	S5617_267_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	268	0		29	10	S5617_268_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	268	0		29	10	S5617_268_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	268	0		29	10	S5617_268_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	268	0		29	10	S5617_268_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	268	0		29	10	S5617_268_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	268	0		29	10	S5617_268_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											74.43	50	50	50				54.64	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	268	0		29	10	S5617_268_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	268	0		29	10	S5617_268_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	269	0		29	10	S5617_269_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	269	0		29	10	S5617_269_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	269	0		29	10	S5617_269_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	269	0		29	10	S5617_269_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	269	0		29	10	S5617_269_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	269	0		29	10	S5617_269_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											73.65	50	50	50				59.8	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	269	0		29	10	S5617_269_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	269	0		29	10	S5617_269_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	270	0		29	10	S5617_270_0	2	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	270	0		29	10	S5617_270_0	2	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	270	0		29	10	S5617_270_0	2	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	270	0		29	10	S5617_270_0	2	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	270	0		29	10	S5617_270_0	2	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	270	0		29	10	S5617_270_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											86.81	50	50	50				57.85	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	270	0		29	10	S5617_270_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	270	0		29	10	S5617_270_0	2	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	271	0		29	10	S5617_271_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	271	0		29	10	S5617_271_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	271	0		29	10	S5617_271_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	271	0		29	10	S5617_271_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	271	0		29	10	S5617_271_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	271	0		29	10	S5617_271_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.8	50	50	50				65.43	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	271	0		29	10	S5617_271_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	271	0		29	10	S5617_271_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	272	0		29	10	S5617_272_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	272	0		29	10	S5617_272_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	272	0		29	10	S5617_272_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	272	0		29	10	S5617_272_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	272	0		29	10	S5617_272_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	272	0		29	10	S5617_272_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											93.51	50	50	50				66.44	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	272	0		29	10	S5617_272_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	272	0		29	10	S5617_272_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	273	0		29	10	S5617_273_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	273	0		29	10	S5617_273_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	273	0		29	10	S5617_273_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	273	0		29	10	S5617_273_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	273	0		29	10	S5617_273_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	273	0		29	10	S5617_273_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											96.97	50	50	50				64.53	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	273	0		29	10	S5617_273_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	273	0		29	10	S5617_273_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	274	0		29	10	S5617_274_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	274	0		29	10	S5617_274_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	274	0		29	10	S5617_274_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	274	0		29	10	S5617_274_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	274	0		29	10	S5617_274_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	274	0		29	10	S5617_274_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.42	50	50	50				63.6	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	274	0		29	10	S5617_274_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	274	0		29	10	S5617_274_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	275	0		29	10	S5617_275_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	275	0		29	10	S5617_275_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	275	0		29	10	S5617_275_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	275	0		29	10	S5617_275_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	275	0		29	10	S5617_275_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	275	0		29	10	S5617_275_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											77.35	50	50	50				60.42	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	275	0		29	10	S5617_275_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	275	0		29	10	S5617_275_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	276	0		29	10	S5617_276_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	276	0		29	10	S5617_276_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	276	0		29	10	S5617_276_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	276	0		29	10	S5617_276_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	276	0		29	10	S5617_276_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	276	0		29	10	S5617_276_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											99.36	49	49	49				70.62	49	49	49										49	49	49				49	49	49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	276	0		29	10	S5617_276_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	276	0		29	10	S5617_276_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	277	0		29	10	S5617_277_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	277	0		29	10	S5617_277_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	277	0		29	10	S5617_277_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	277	0		29	10	S5617_277_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	277	0		29	10	S5617_277_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	277	0		29	10	S5617_277_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											84.81	50	50	50				68.49	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	277	0		29	10	S5617_277_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	277	0		29	10	S5617_277_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	278	0		29	10	S5617_278_0	2	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	278	0		29	10	S5617_278_0	2	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	278	0		29	10	S5617_278_0	2	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	278	0		29	10	S5617_278_0	2	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	278	0		29	10	S5617_278_0	2	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	278	0		29	10	S5617_278_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											91.02	50	50	50				65.77	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	278	0		29	10	S5617_278_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	278	0		29	10	S5617_278_0	2	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	279	0		29	10	S5617_279_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	279	0		29	10	S5617_279_0	1	Preferred Generic	4	1	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					4	8	12											15	30	45				4	8	0				15				15			0.5	0.13		0.5	0.13	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	279	0		29	10	S5617_279_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	279	0		29	10	S5617_279_0	1	Generic	4	1	1	2	2	3		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					10	20	30											20	40	60				10	20	20				20				20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"										1		
S5617	279	0		29	10	S5617_279_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								47	94	141					42	84	126											47	94	141				42	84	105				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	279	0		29	10	S5617_279_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											90.34	50	50	50				65.36	50	50	50										50	50	50				50	50	50			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	279	0		29	10	S5617_279_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												31							31												31						31					31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	279	0		29	10	S5617_279_0	1	Select Care Drugs	4	11	1	2	6	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								11	22	33					2	4	6											11	22	33				2	4	4				11				11			0.37	0.07		0.37	0.07	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S5617	280	0		29	10	S5617_280_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	280	0		29	10	S5617_280_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	280	0		29	10	S5617_280_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											40.14	20	20	20				40.42	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	280	0		29	10	S5617_280_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.5	50	50	50				69.36	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	280	0		29	10	S5617_280_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	281	0		29	10	S5617_281_0	2	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	281	0		29	10	S5617_281_0	2	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	281	0		29	10	S5617_281_0	2	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											40.59	20	20	20				40.83	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	281	0		29	10	S5617_281_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											99.44	45	45	45				69.7	43	43	43										45	45	45				43	43	43			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	281	0		29	10	S5617_281_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	282	0		29	10	S5617_282_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	282	0		29	10	S5617_282_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	282	0		29	10	S5617_282_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.52	20	20	20				41.44	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	282	0		29	10	S5617_282_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.27	49	49	49				70.34	42	42	42										49	49	49				42	42	42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	282	0		29	10	S5617_282_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	283	0		29	10	S5617_283_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	283	0		29	10	S5617_283_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	283	0		29	10	S5617_283_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.39	20	20	20				42.59	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	283	0		29	10	S5617_283_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											93.13	50	50	50				68.22	41	41	41										50	50	50				41	41	41			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	283	0		29	10	S5617_283_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	284	0		29	10	S5617_284_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	284	0		29	10	S5617_284_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	284	0		29	10	S5617_284_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											42.77	20	20	20				40.42	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	284	0		29	10	S5617_284_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.72	48	48	48				69.74	43	43	43										48	48	48				43	43	43			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	284	0		29	10	S5617_284_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	285	0		29	10	S5617_285_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	285	0		29	10	S5617_285_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	285	0		29	10	S5617_285_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											42.38	20	20	20				40.6	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	285	0		29	10	S5617_285_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.48	50	50	50				69.31	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	285	0		29	10	S5617_285_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	286	0		29	10	S5617_286_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	286	0		29	10	S5617_286_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	286	0		29	10	S5617_286_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.29	20	20	20				40	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	286	0		29	10	S5617_286_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.5	50	50	50				68.96	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	286	0		29	10	S5617_286_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	287	0		29	10	S5617_287_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	287	0		29	10	S5617_287_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	287	0		29	10	S5617_287_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											40.6	20	20	20				38.66	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	287	0		29	10	S5617_287_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											96	50	50	50				67.1	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	287	0		29	10	S5617_287_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	288	0		29	10	S5617_288_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	288	0		29	10	S5617_288_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	288	0		29	10	S5617_288_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.88	20	20	20				40.46	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	288	0		29	10	S5617_288_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.26	50	50	50				68.48	42	42	42										50	50	50				42	42	42			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	288	0		29	10	S5617_288_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	289	0		29	10	S5617_289_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	289	0		29	10	S5617_289_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	289	0		29	10	S5617_289_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.95	20	20	20				39.33	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	289	0		29	10	S5617_289_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.62	48	48	48				65.11	41	41	41										48	48	48				41	41	41			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	289	0		29	10	S5617_289_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	290	0		29	10	S5617_290_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	290	0		29	10	S5617_290_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	290	0		29	10	S5617_290_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.62	20	20	20				40.18	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	290	0		29	10	S5617_290_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											93.72	50	50	50				67.62	42	42	42										50	50	50				42	42	42			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	290	0		29	10	S5617_290_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	291	0		29	10	S5617_291_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	291	0		29	10	S5617_291_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	291	0		29	10	S5617_291_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.93	20	20	20				39.26	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	291	0		29	10	S5617_291_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.19	50	50	50				65.08	41	41	41										50	50	50				41	41	41			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	291	0		29	10	S5617_291_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	292	0		29	10	S5617_292_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	292	0		29	10	S5617_292_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	292	0		29	10	S5617_292_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.98	20	20	20				40.18	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	292	0		29	10	S5617_292_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.16	50	50	50				69.21	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	292	0		29	10	S5617_292_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	293	0		29	10	S5617_293_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	293	0		29	10	S5617_293_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	293	0		29	10	S5617_293_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.34	20	20	20				39.21	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	293	0		29	10	S5617_293_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.52	50	50	50				69.03	44	44	44										50	50	50				44	44	44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	293	0		29	10	S5617_293_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	294	0		29	10	S5617_294_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	294	0		29	10	S5617_294_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	294	0		29	10	S5617_294_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											38.34	20	20	20				37.36	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	294	0		29	10	S5617_294_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											89.29	50	50	50				64.49	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	294	0		29	10	S5617_294_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	295	0		29	10	S5617_295_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	295	0		29	10	S5617_295_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	295	0		29	10	S5617_295_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											38.66	20	20	20				38.45	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	295	0		29	10	S5617_295_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											88.98	50	50	50				67.7	44	44	44										50	50	50				44	44	44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	295	0		29	10	S5617_295_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	296	0		29	10	S5617_296_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	296	0		29	10	S5617_296_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	296	0		29	10	S5617_296_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											38.96	20	20	20				38.76	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	296	0		29	10	S5617_296_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.08	50	50	50				68.49	44	44	44										50	50	50				44	44	44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	296	0		29	10	S5617_296_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	297	0		29	10	S5617_297_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	297	0		29	10	S5617_297_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	297	0		29	10	S5617_297_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.5	20	20	20				38.09	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	297	0		29	10	S5617_297_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.41	50	50	50				64.31	42	42	42										50	50	50				42	42	42			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	297	0		29	10	S5617_297_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	298	0		29	10	S5617_298_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	298	0		29	10	S5617_298_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	298	0		29	10	S5617_298_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											40.08	20	20	20				37.64	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	298	0		29	10	S5617_298_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.79	50	50	50				62.34	41	41	41										50	50	50				41	41	41			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	298	0		29	10	S5617_298_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	299	0		29	10	S5617_299_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	299	0		29	10	S5617_299_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	299	0		29	10	S5617_299_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											40.31	20	20	20				38.13	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	299	0		29	10	S5617_299_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.16	50	50	50				63.44	41	41	41										50	50	50				41	41	41			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	299	0		29	10	S5617_299_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	300	0		29	10	S5617_300_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	300	0		29	10	S5617_300_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	300	0		29	10	S5617_300_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.92	20	20	20				39.38	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	300	0		29	10	S5617_300_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.21	50	50	50				66.51	42	42	42										50	50	50				42	42	42			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	300	0		29	10	S5617_300_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	301	0		29	10	S5617_301_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	301	0		29	10	S5617_301_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	301	0		29	10	S5617_301_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.99	20	20	20				39.6	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	301	0		29	10	S5617_301_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.22	48	48	48				68.19	43	43	43										48	48	48				43	43	43			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	301	0		29	10	S5617_301_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	302	0		29	10	S5617_302_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	302	0		29	10	S5617_302_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	302	0		29	10	S5617_302_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											38.52	20	20	20				39.09	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	302	0		29	10	S5617_302_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											92.05	50	50	50				64.59	42	42	42										50	50	50				42	42	42			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	302	0		29	10	S5617_302_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	303	0		29	10	S5617_303_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	303	0		29	10	S5617_303_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	303	0		29	10	S5617_303_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											38.25	20	20	20				36.48	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	303	0		29	10	S5617_303_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											89.42	50	50	50				64.47	44	44	44										50	50	50				44	44	44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	303	0		29	10	S5617_303_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	304	0		29	10	S5617_304_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	304	0		29	10	S5617_304_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	304	0		29	10	S5617_304_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											38.16	20	20	20				38.08	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	304	0		29	10	S5617_304_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											91.92	50	50	50				67.14	44	44	44										50	50	50				44	44	44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	304	0		29	10	S5617_304_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	305	0		29	10	S5617_305_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	305	0		29	10	S5617_305_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	305	0		29	10	S5617_305_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											42.52	20	20	20				41.3	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	305	0		29	10	S5617_305_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.3	48	48	48				71.23	43	43	43										48	48	48				43	43	43			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	305	0		29	10	S5617_305_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	306	0		29	10	S5617_306_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	306	0		29	10	S5617_306_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	306	0		29	10	S5617_306_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											40.76	20	20	20				40.04	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	306	0		29	10	S5617_306_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.96	50	50	50				70.37	44	44	44										50	50	50				44	44	44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	306	0		29	10	S5617_306_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	307	0		29	10	S5617_307_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	307	0		29	10	S5617_307_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	307	0		29	10	S5617_307_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.99	20	20	20				39.54	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	307	0		29	10	S5617_307_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.55	50	50	50				70.93	45	45	45										50	50	50				45	45	45			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	307	0		29	10	S5617_307_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	308	0		29	10	S5617_308_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	308	0		29	10	S5617_308_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	308	0		29	10	S5617_308_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.57	20	20	20				38.35	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	308	0		29	10	S5617_308_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											95.07	50	50	50				66.23	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	308	0		29	10	S5617_308_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	309	0		29	10	S5617_309_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	309	0		29	10	S5617_309_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	309	0		29	10	S5617_309_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.99	20	20	20				39.95	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	309	0		29	10	S5617_309_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											94.52	50	50	50				68.49	43	43	43										50	50	50				43	43	43			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	309	0		29	10	S5617_309_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	310	0		29	10	S5617_310_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	310	0		29	10	S5617_310_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	310	0		29	10	S5617_310_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											37.43	20	20	20				38.23	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	310	0		29	10	S5617_310_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											90.78	50	50	50				67.22	44	44	44										50	50	50				44	44	44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	310	0		29	10	S5617_310_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	311	0		29	10	S5617_311_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	311	0		29	10	S5617_311_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	311	0		29	10	S5617_311_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											41.25	20	20	20				40.59	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	311	0		29	10	S5617_311_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											86.47	47	47	47				63.59	40	40	40										47	47	47				40	40	40			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	311	0		29	10	S5617_311_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	312	0		29	10	S5617_312_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	312	0		29	10	S5617_312_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	312	0		29	10	S5617_312_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											45.13	20	20	20				40.79	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	312	0		29	10	S5617_312_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											98.01	48	48	48				72.96	45	45	45										48	48	48				45	45	45			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	312	0		29	10	S5617_312_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	313	0		29	10	S5617_313_0	1	Preferred Generic	4	1	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								19	38	57					0	0	0											19	38	57				0	0	0				19				19			0.63	0		0.63	0	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	313	0		29	10	S5617_313_0	1	Generic	4	1	1	2	2	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31								20	40	60					2	4	6											20	40	60				2	4	4				20				20			0.67	0.07		0.67	0.07	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	313	0		29	10	S5617_313_0	1	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											39.68	20	20	20				39.84	18	18	18										20	20	20				18	18	18			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	313	0		29	10	S5617_313_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	2	2				30	60	90	30		31											96.31	50	50	50				66.92	42	42	42										50	50	50				42	42	42			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5617	313	0		29	10	S5617_313_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	104	0		29	10	S5660_104_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	104	0		29	10	S5660_104_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	104	0		29	10	S5660_104_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	104	0		29	10	S5660_104_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.72	41						49.05	39												41						41					41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	104	0		29	10	S5660_104_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	105	0		29	10	S5660_105_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	105	0		29	10	S5660_105_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	105	0		29	10	S5660_105_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											66.82	40						58.43	38												40						40					40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	105	0		29	10	S5660_105_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	106	0		29	10	S5660_106_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	106	0		29	10	S5660_106_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	106	0		29	10	S5660_106_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											57.18	34						54.63	32												34						34					34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	106	0		29	10	S5660_106_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	107	0		29	10	S5660_107_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	107	0		29	10	S5660_107_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	107	0		29	10	S5660_107_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											70.5	37						65.69	35												37						37					37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	107	0		29	10	S5660_107_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	108	0		29	10	S5660_108_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	108	0		29	10	S5660_108_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	108	0		29	10	S5660_108_0	2	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											52.34	34						52.03	32												34						34					34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	108	0		29	10	S5660_108_0	2	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	109	0		29	10	S5660_109_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	109	0		29	10	S5660_109_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	109	0		29	10	S5660_109_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											72.28	46						58.22	44												46						46					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	109	0		29	10	S5660_109_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	110	0		29	10	S5660_110_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	110	0		29	10	S5660_110_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	110	0		29	10	S5660_110_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											64.09	49						58	47												49						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	110	0		29	10	S5660_110_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	111	0		29	10	S5660_111_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	111	0		29	10	S5660_111_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	111	0		29	10	S5660_111_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											62.31	46						50.06	44												46						46					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	111	0		29	10	S5660_111_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	112	0		29	10	S5660_112_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	112	0		29	10	S5660_112_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	112	0		29	10	S5660_112_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											56.81	43						45.69	41												43						43					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	112	0		29	10	S5660_112_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	113	0		29	10	S5660_113_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	113	0		29	10	S5660_113_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	113	0		29	10	S5660_113_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											67.4	47						54.07	45												47						47					47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	113	0		29	10	S5660_113_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	114	0		29	10	S5660_114_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	114	0		29	10	S5660_114_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	114	0		29	10	S5660_114_0	2	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											47.46	36						47.66	34												36						36					36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	114	0		29	10	S5660_114_0	2	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	115	0		29	10	S5660_115_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	115	0		29	10	S5660_115_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	115	0		29	10	S5660_115_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											56.84	40						54.68	38												40						40					40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	115	0		29	10	S5660_115_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	116	0		29	10	S5660_116_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	116	0		29	10	S5660_116_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	116	0		29	10	S5660_116_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											67.36	49						50.91	47												49						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	116	0		29	10	S5660_116_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	117	0		29	10	S5660_117_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	117	0		29	10	S5660_117_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	117	0		29	10	S5660_117_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											48.14	36						44.74	34												36						36					36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	117	0		29	10	S5660_117_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	118	0		29	10	S5660_118_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	118	0		29	10	S5660_118_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	118	0		29	10	S5660_118_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											57.33	41						51.3	39												41						41					41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	118	0		29	10	S5660_118_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	119	0		29	10	S5660_119_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	119	0		29	10	S5660_119_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	119	0		29	10	S5660_119_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											73.55	49						58.98	47												49						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	119	0		29	10	S5660_119_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	120	0		29	10	S5660_120_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	120	0		29	10	S5660_120_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	120	0		29	10	S5660_120_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											61.3	46						48.85	44												46						46					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	120	0		29	10	S5660_120_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	121	0		29	10	S5660_121_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	121	0		29	10	S5660_121_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	121	0		29	10	S5660_121_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											60.24	48						50.04	46												48						48					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	121	0		29	10	S5660_121_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	122	0		29	10	S5660_122_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	122	0		29	10	S5660_122_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	122	0		29	10	S5660_122_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											59.56	48						56.46	46												48						48					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	122	0		29	10	S5660_122_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	123	0		29	10	S5660_123_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	123	0		29	10	S5660_123_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	123	0		29	10	S5660_123_0	2	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											47.33	32						48.02	30												32						32					32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	123	0		29	10	S5660_123_0	2	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	124	0		29	10	S5660_124_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	124	0		29	10	S5660_124_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	124	0		29	10	S5660_124_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											62.43	47						46.66	45												47						47					47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	124	0		29	10	S5660_124_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	125	0		29	10	S5660_125_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	125	0		29	10	S5660_125_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	125	0		29	10	S5660_125_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											44.7	38						39.26	36												38						38					38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	125	0		29	10	S5660_125_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	126	0		29	10	S5660_126_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	126	0		29	10	S5660_126_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	126	0		29	10	S5660_126_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											61.15	48						50.76	46												48						48					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	126	0		29	10	S5660_126_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	127	0		29	10	S5660_127_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	127	0		29	10	S5660_127_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								38		114					28		84													84						84				38				38			1.27	0.93				1.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	127	0		29	10	S5660_127_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											65.75	50						54.7	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	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	128	0		29	10	S5660_128_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	128	0		29	10	S5660_128_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					29		87													87						87				39				39			1.3	0.97				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	128	0		29	10	S5660_128_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											76	50						58.18	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	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	129	0		29	10	S5660_129_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	129	0		29	10	S5660_129_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								37		111					27		81													81						81				37				37			1.23	0.9				1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	129	0		29	10	S5660_129_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											68.61	50						60.79	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	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	130	0		29	10	S5660_130_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	130	0		29	10	S5660_130_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								37		111					27		81													81						81				37				37			1.23	0.9				1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	130	0		29	10	S5660_130_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											99.29	43						76.48	41												43						43					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	130	0		29	10	S5660_130_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	131	0		29	10	S5660_131_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	131	0		29	10	S5660_131_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								38		114					28		84													84						84				38				38			1.27	0.93				1.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	131	0		29	10	S5660_131_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											69.2	50						52.5	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	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	132	0		29	10	S5660_132_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	132	0		29	10	S5660_132_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	132	0		29	10	S5660_132_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											64.07	46						48.26	44												46						46					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	132	0		29	10	S5660_132_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	133	0		29	10	S5660_133_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	133	0		29	10	S5660_133_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	133	0		29	10	S5660_133_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											55.69	37						51.83	35												37						37					37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	133	0		29	10	S5660_133_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	134	0		29	10	S5660_134_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	134	0		29	10	S5660_134_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	134	0		29	10	S5660_134_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											56.11	43						51.46	41												43						43					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	134	0		29	10	S5660_134_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	135	0		29	10	S5660_135_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	135	0		29	10	S5660_135_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	135	0		29	10	S5660_135_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											77.14	46						62.39	44												46						46					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	135	0		29	10	S5660_135_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	136	0		29	10	S5660_136_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	136	0		29	10	S5660_136_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	136	0		29	10	S5660_136_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											57.17	38						53.07	36												38						38					38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	136	0		29	10	S5660_136_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	137	0		29	10	S5660_137_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	137	0		29	10	S5660_137_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								37		111					27		81													81						81				37				37			1.23	0.9				1.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	137	0		29	10	S5660_137_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											65.18	50						48.95	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	11	1	1	5	1		10	1		10	1				30								30			30		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	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	172	0		29	10	S5660_172_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	172	0		29	10	S5660_172_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	172	0		29	10	S5660_172_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	172	0		29	10	S5660_172_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	172	0		29	10	S5660_172_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											86.91	50						71.07	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	176	0		29	10	S5660_176_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	176	0		29	10	S5660_176_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	176	0		29	10	S5660_176_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	176	0		29	10	S5660_176_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	176	0		29	10	S5660_176_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	176	0		29	10	S5660_176_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											75.47	50						59.14	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	180	0		29	10	S5660_180_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	180	0		29	10	S5660_180_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	180	0		29	10	S5660_180_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	180	0		29	10	S5660_180_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	180	0		29	10	S5660_180_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	180	0		29	10	S5660_180_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											97.56	50						78.01	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	181	0		29	10	S5660_181_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	181	0		29	10	S5660_181_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	181	0		29	10	S5660_181_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	181	0		29	10	S5660_181_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	181	0		29	10	S5660_181_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	181	0		29	10	S5660_181_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											98.37	48						72.48	46												50						48					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	181	0		29	10	S5660_181_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	182	0		29	10	S5660_182_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	182	0		29	10	S5660_182_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	182	0		29	10	S5660_182_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	182	0		29	10	S5660_182_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	182	0		29	10	S5660_182_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	182	0		29	10	S5660_182_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											92.84	50						80	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	183	0		29	10	S5660_183_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	183	0		29	10	S5660_183_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	183	0		29	10	S5660_183_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	183	0		29	10	S5660_183_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	183	0		29	10	S5660_183_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	183	0		29	10	S5660_183_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											98.32	49						90.79	47												51						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	183	0		29	10	S5660_183_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	184	0		29	10	S5660_184_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	184	0		29	10	S5660_184_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	184	0		29	10	S5660_184_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	184	0		29	10	S5660_184_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	184	0		29	10	S5660_184_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	184	0		29	10	S5660_184_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											79.84	50						66.92	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	185	0		29	10	S5660_185_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	185	0		29	10	S5660_185_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	185	0		29	10	S5660_185_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	185	0		29	10	S5660_185_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	185	0		29	10	S5660_185_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	185	0		29	10	S5660_185_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											81.88	50						66.31	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	186	0		29	10	S5660_186_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	186	0		29	10	S5660_186_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	186	0		29	10	S5660_186_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	186	0		29	10	S5660_186_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	186	0		29	10	S5660_186_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	186	0		29	10	S5660_186_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											89.1	50						72.36	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	187	0		29	10	S5660_187_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	187	0		29	10	S5660_187_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	187	0		29	10	S5660_187_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	187	0		29	10	S5660_187_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	187	0		29	10	S5660_187_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	187	0		29	10	S5660_187_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											89.85	50						77.19	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	190	0		29	10	S5660_190_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	190	0		29	10	S5660_190_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	190	0		29	10	S5660_190_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	190	0		29	10	S5660_190_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	190	0		29	10	S5660_190_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	190	0		29	10	S5660_190_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											83.91	50						70.98	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	192	0		29	10	S5660_192_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	192	0		29	10	S5660_192_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	192	0		29	10	S5660_192_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	192	0		29	10	S5660_192_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	192	0		29	10	S5660_192_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	192	0		29	10	S5660_192_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											89.94	50						66.54	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	194	0		29	10	S5660_194_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	194	0		29	10	S5660_194_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	194	0		29	10	S5660_194_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	194	0		29	10	S5660_194_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	194	0		29	10	S5660_194_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	194	0		29	10	S5660_194_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											89.54	50						63.91	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	195	0		29	10	S5660_195_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	195	0		29	10	S5660_195_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	195	0		29	10	S5660_195_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	195	0		29	10	S5660_195_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	195	0		29	10	S5660_195_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	195	0		29	10	S5660_195_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											83.14	50						69.83	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	196	0		29	10	S5660_196_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	196	0		29	10	S5660_196_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	196	0		29	10	S5660_196_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	196	0		29	10	S5660_196_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	196	0		29	10	S5660_196_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	196	0		29	10	S5660_196_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											87.51	50						68.86	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	197	0		29	10	S5660_197_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	197	0		29	10	S5660_197_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	197	0		29	10	S5660_197_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	197	0		29	10	S5660_197_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	197	0		29	10	S5660_197_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	197	0		29	10	S5660_197_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											84.19	50						70.89	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	198	0		29	10	S5660_198_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	198	0		29	10	S5660_198_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	198	0		29	10	S5660_198_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	198	0		29	10	S5660_198_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	198	0		29	10	S5660_198_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	198	0		29	10	S5660_198_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											93.43	50						68.28	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	199	0		29	10	S5660_199_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	199	0		29	10	S5660_199_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	199	0		29	10	S5660_199_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	199	0		29	10	S5660_199_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	199	0		29	10	S5660_199_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	199	0		29	10	S5660_199_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											94.87	50						70.1	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	202	0		29	10	S5660_202_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	202	0		29	10	S5660_202_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	202	0		29	10	S5660_202_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	202	0		29	10	S5660_202_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	202	0		29	10	S5660_202_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	202	0		29	10	S5660_202_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											98.3	49						79.64	47												51						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	202	0		29	10	S5660_202_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	203	0		29	10	S5660_203_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	203	0		29	10	S5660_203_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	203	0		29	10	S5660_203_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	203	0		29	10	S5660_203_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	203	0		29	10	S5660_203_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	203	0		29	10	S5660_203_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											95.68	50						87.14	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	204	0		29	10	S5660_204_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	204	0		29	10	S5660_204_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	204	0		29	10	S5660_204_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	204	0		29	10	S5660_204_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	204	0		29	10	S5660_204_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	204	0		29	10	S5660_204_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											95.16	50						74.93	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	206	0		29	10	S5660_206_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	206	0		29	10	S5660_206_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	206	0		29	10	S5660_206_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	206	0		29	10	S5660_206_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	206	0		29	10	S5660_206_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	206	0		29	10	S5660_206_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											97.04	50						75.9	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	207	0		29	10	S5660_207_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	207	0		29	10	S5660_207_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	207	0		29	10	S5660_207_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	207	0		29	10	S5660_207_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	207	0		29	10	S5660_207_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	207	0		29	10	S5660_207_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											97.65	50						78.89	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	208	0		29	10	S5660_208_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	208	0		29	10	S5660_208_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	208	0		29	10	S5660_208_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	208	0		29	10	S5660_208_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	208	0		29	10	S5660_208_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	208	0		29	10	S5660_208_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											92.7	50						66.91	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	209	0		29	10	S5660_209_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	209	0		29	10	S5660_209_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	209	0		29	10	S5660_209_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	209	0		29	10	S5660_209_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	209	0		29	10	S5660_209_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	209	0		29	10	S5660_209_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											88.69	50						78.21	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	210	0		29	10	S5660_210_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	210	0		29	10	S5660_210_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	210	0		29	10	S5660_210_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	210	0		29	10	S5660_210_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	210	0		29	10	S5660_210_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	210	0		29	10	S5660_210_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											92.81	50						64.33	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	211	0		29	10	S5660_211_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	211	0		29	10	S5660_211_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	211	0		29	10	S5660_211_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	211	0		29	10	S5660_211_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	211	0		29	10	S5660_211_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	211	0		29	10	S5660_211_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											87.88	50						68.05	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	212	0		29	10	S5660_212_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	212	0		29	10	S5660_212_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	212	0		29	10	S5660_212_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	212	0		29	10	S5660_212_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	212	0		29	10	S5660_212_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	212	0		29	10	S5660_212_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											82.67	50						70.22	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	213	0		29	10	S5660_213_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	213	0		29	10	S5660_213_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	213	0		29	10	S5660_213_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	213	0		29	10	S5660_213_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	213	0		29	10	S5660_213_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	213	0		29	10	S5660_213_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											90.71	50						82.68	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	214	0		29	10	S5660_214_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	214	0		29	10	S5660_214_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	214	0		29	10	S5660_214_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	214	0		29	10	S5660_214_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	214	0		29	10	S5660_214_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	214	0		29	10	S5660_214_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											94.83	50						72.35	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	215	0		29	10	S5660_215_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	215	0		29	10	S5660_215_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	215	0		29	10	S5660_215_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	215	0		29	10	S5660_215_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	215	0		29	10	S5660_215_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	215	0		29	10	S5660_215_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											86.88	50						68.36	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	216	0		29	10	S5660_216_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	216	0		29	10	S5660_216_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	216	0		29	10	S5660_216_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	216	0		29	10	S5660_216_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	216	0		29	10	S5660_216_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	216	0		29	10	S5660_216_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											92.23	50						70.8	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	217	0		29	10	S5660_217_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	217	0		29	10	S5660_217_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	217	0		29	10	S5660_217_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	217	0		29	10	S5660_217_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5660	217	0		29	10	S5660_217_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	217	0		29	10	S5660_217_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											80.55	50						61.42	48												52						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	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	218	0		29	10	S5660_218_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	218	0		29	10	S5660_218_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	218	0		29	10	S5660_218_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	218	0		29	10	S5660_218_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											66	50						50.11	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	218	0		29	10	S5660_218_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	219	0		29	10	S5660_219_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	219	0		29	10	S5660_219_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	219	0		29	10	S5660_219_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	219	0		29	10	S5660_219_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											76.71	50						66.34	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	219	0		29	10	S5660_219_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	220	0		29	10	S5660_220_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	220	0		29	10	S5660_220_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	220	0		29	10	S5660_220_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	220	0		29	10	S5660_220_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											66.81	43						53.24	41												45						43					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	220	0		29	10	S5660_220_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	221	0		29	10	S5660_221_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	221	0		29	10	S5660_221_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	221	0		29	10	S5660_221_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	221	0		29	10	S5660_221_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											63.2	45						56.68	43												47						45					45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	221	0		29	10	S5660_221_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	222	0		29	10	S5660_222_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	222	0		29	10	S5660_222_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	222	0		29	10	S5660_222_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	222	0		29	10	S5660_222_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											53.56	49						45.01	47												51						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	222	0		29	10	S5660_222_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	223	0		29	10	S5660_223_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	223	0		29	10	S5660_223_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	223	0		29	10	S5660_223_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	223	0		29	10	S5660_223_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											75.16	47						58.58	45												49						47					47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	223	0		29	10	S5660_223_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	224	0		29	10	S5660_224_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	224	0		29	10	S5660_224_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	224	0		29	10	S5660_224_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	224	0		29	10	S5660_224_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											60.08	48						44.35	46												50						48					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	224	0		29	10	S5660_224_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	225	0		29	10	S5660_225_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	225	0		29	10	S5660_225_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	225	0		29	10	S5660_225_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	225	0		29	10	S5660_225_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											55.3	43						45.02	41												45						43					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	225	0		29	10	S5660_225_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	226	0		29	10	S5660_226_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	226	0		29	10	S5660_226_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	226	0		29	10	S5660_226_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	226	0		29	10	S5660_226_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											45.25	40						38.87	38												42						40					40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	226	0		29	10	S5660_226_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	227	0		29	10	S5660_227_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	227	0		29	10	S5660_227_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	227	0		29	10	S5660_227_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	227	0		29	10	S5660_227_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											60.61	45						48.09	43												47						45					45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	227	0		29	10	S5660_227_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	228	0		29	10	S5660_228_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	228	0		29	10	S5660_228_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	228	0		29	10	S5660_228_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	228	0		29	10	S5660_228_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											43.08	41						37.21	39												43						41					41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	228	0		29	10	S5660_228_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	229	0		29	10	S5660_229_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	229	0		29	10	S5660_229_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	229	0		29	10	S5660_229_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	229	0		29	10	S5660_229_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											51.85	38						52.02	36												40						38					38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	229	0		29	10	S5660_229_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	230	0		29	10	S5660_230_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	230	0		29	10	S5660_230_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	230	0		29	10	S5660_230_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	230	0		29	10	S5660_230_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											58.75	50						42.2	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	230	0		29	10	S5660_230_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	231	0		29	10	S5660_231_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	231	0		29	10	S5660_231_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	231	0		29	10	S5660_231_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	231	0		29	10	S5660_231_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											56.26	48						40.9	46												50						48					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	231	0		29	10	S5660_231_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	232	0		29	10	S5660_232_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	232	0		29	10	S5660_232_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	232	0		29	10	S5660_232_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	232	0		29	10	S5660_232_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											76.27	50						57.65	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	232	0		29	10	S5660_232_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	233	0		29	10	S5660_233_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	233	0		29	10	S5660_233_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	233	0		29	10	S5660_233_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	233	0		29	10	S5660_233_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											73.62	50						57.87	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	233	0		29	10	S5660_233_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	234	0		29	10	S5660_234_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	234	0		29	10	S5660_234_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	234	0		29	10	S5660_234_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	234	0		29	10	S5660_234_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											52.13	50						40.5	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	234	0		29	10	S5660_234_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	235	0		29	10	S5660_235_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	235	0		29	10	S5660_235_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	235	0		29	10	S5660_235_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	235	0		29	10	S5660_235_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											51.54	44						45.74	42												46						44					44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	235	0		29	10	S5660_235_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	236	0		29	10	S5660_236_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	236	0		29	10	S5660_236_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	236	0		29	10	S5660_236_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	236	0		29	10	S5660_236_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											51.79	43						38.92	41												45						43					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	236	0		29	10	S5660_236_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	237	0		29	10	S5660_237_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	237	0		29	10	S5660_237_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	237	0		29	10	S5660_237_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	237	0		29	10	S5660_237_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											47.93	39						35.26	37												41						39					39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	237	0		29	10	S5660_237_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	238	0		29	10	S5660_238_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	238	0		29	10	S5660_238_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	238	0		29	10	S5660_238_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	238	0		29	10	S5660_238_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											63.98	49						51.48	47												51						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	238	0		29	10	S5660_238_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	239	0		29	10	S5660_239_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	239	0		29	10	S5660_239_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	239	0		29	10	S5660_239_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	239	0		29	10	S5660_239_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											49.86	40						38.1	38												42						40					40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	239	0		29	10	S5660_239_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	240	0		29	10	S5660_240_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	240	0		29	10	S5660_240_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	240	0		29	10	S5660_240_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	240	0		29	10	S5660_240_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											65.87	50						60.51	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	240	0		29	10	S5660_240_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	241	0		29	10	S5660_241_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	241	0		29	10	S5660_241_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	241	0		29	10	S5660_241_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	241	0		29	10	S5660_241_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											67.52	50						45.8	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	241	0		29	10	S5660_241_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	242	0		29	10	S5660_242_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	242	0		29	10	S5660_242_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	242	0		29	10	S5660_242_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	242	0		29	10	S5660_242_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											63.37	46						58.35	44												48						46					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	242	0		29	10	S5660_242_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	243	0		29	10	S5660_243_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	243	0		29	10	S5660_243_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	243	0		29	10	S5660_243_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	243	0		29	10	S5660_243_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											81.82	48						75.59	46												50						48					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	243	0		29	10	S5660_243_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	244	0		29	10	S5660_244_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	244	0		29	10	S5660_244_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	244	0		29	10	S5660_244_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	244	0		29	10	S5660_244_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											69.48	47						54.33	45												49						47					47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	244	0		29	10	S5660_244_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	245	0		29	10	S5660_245_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	245	0		29	10	S5660_245_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	245	0		29	10	S5660_245_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	245	0		29	10	S5660_245_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											64.28	50						54.36	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	245	0		29	10	S5660_245_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	246	0		29	10	S5660_246_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	246	0		29	10	S5660_246_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	246	0		29	10	S5660_246_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	246	0		29	10	S5660_246_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											62.99	49						43.02	47												51						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	246	0		29	10	S5660_246_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	247	0		29	10	S5660_247_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	247	0		29	10	S5660_247_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	247	0		29	10	S5660_247_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	247	0		29	10	S5660_247_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											62.16	43						50.19	41												45						43					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	247	0		29	10	S5660_247_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	248	0		29	10	S5660_248_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	248	0		29	10	S5660_248_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	248	0		29	10	S5660_248_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	248	0		29	10	S5660_248_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											68.97	50						55.43	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	248	0		29	10	S5660_248_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	249	0		29	10	S5660_249_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	249	0		29	10	S5660_249_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	249	0		29	10	S5660_249_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	249	0		29	10	S5660_249_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											76.32	49						58.71	47												51						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	249	0		29	10	S5660_249_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	250	0		29	10	S5660_250_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	250	0		29	10	S5660_250_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	250	0		29	10	S5660_250_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	250	0		29	10	S5660_250_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											71.03	42						59.48	40												44						42					42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	250	0		29	10	S5660_250_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	251	0		29	10	S5660_251_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	251	0		29	10	S5660_251_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	251	0		29	10	S5660_251_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	251	0		29	10	S5660_251_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											66.3	50						43.06	48												52						50					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5660	251	0		29	10	S5660_251_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	1	0		29	10	S5715_001_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	1	0		29	10	S5715_001_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	1	0		29	10	S5715_001_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													42						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	1	0		29	10	S5715_001_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	1	0		29	10	S5715_001_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											59.4	50		50				46.22	40		40												50						40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	1	0		29	10	S5715_001_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	2	0		29	10	S5715_002_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	2	0		29	10	S5715_002_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	2	0		29	10	S5715_002_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								7		21					2		6													21						6				7				7			0.23	0.07				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	2	0		29	10	S5715_002_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					30		90													105						90				35				35			1.17	1				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	2	0		29	10	S5715_002_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											28.31	45		45				30.12	35		35												45						35			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	2	0		29	10	S5715_002_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	3	0		29	10	S5715_003_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	3	0		29	10	S5715_003_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	3	0		29	10	S5715_003_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													42						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	3	0		29	10	S5715_003_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	3	0		29	10	S5715_003_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											57.58	50		50				53.56	40		40												50						40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	3	0		29	10	S5715_003_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	4	0		29	10	S5715_004_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	4	0		29	10	S5715_004_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	4	0		29	10	S5715_004_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								7		21					2		6													21						6				7				7			0.23	0.07				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	4	0		29	10	S5715_004_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					30		90													105						90				35				35			1.17	1				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	4	0		29	10	S5715_004_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											32.63	45		45				25.48	35		35												45						35			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	4	0		29	10	S5715_004_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	5	0		29	10	S5715_005_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	5	0		29	10	S5715_005_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	5	0		29	10	S5715_005_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													42						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	5	0		29	10	S5715_005_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	5	0		29	10	S5715_005_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											65.83	50		50				57.66	40		40												50						40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	5	0		29	10	S5715_005_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	6	0		29	10	S5715_006_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	6	0		29	10	S5715_006_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	6	0		29	10	S5715_006_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								7		21					2		6													21						6				7				7			0.23	0.07				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	6	0		29	10	S5715_006_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					30		90													105						90				35				35			1.17	1				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	6	0		29	10	S5715_006_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											39.98	45		45				28.82	35		35												45						35			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	6	0		29	10	S5715_006_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	10	0		29	10	S5715_010_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	10	0		29	10	S5715_010_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	10	0		29	10	S5715_010_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													42						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	10	0		29	10	S5715_010_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													141						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	10	0		29	10	S5715_010_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											60.09	50		50				44.81	40		40												50						40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	10	0		29	10	S5715_010_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	11	0		29	10	S5715_011_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	11	0		29	10	S5715_011_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								5		15					0		0													15						0				5				5			0.17	0				0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5715	11	0		29	10	S5715_011_0	3	Generic	4	11	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								7		21					2		6													21						6				7				7			0.23	0.07				0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	11	0		29	10	S5715_011_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					30		90													105						90				35				35			1.17	1				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	11	0		29	10	S5715_011_0	3	Non-Preferred Brand	4	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											36.9	45		45				27.62	35		35												45						35			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	11	0		29	10	S5715_011_0	3	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5715	12	0		29	10	S5715_012_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	12	0		29	10	S5715_012_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								9		27					4		12													27						12				9				9			0.3	0.13				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	12	0		29	10	S5715_012_0	2	Preferred Brand	2	11	1	1	3	1		110	1		100	1				30		90	1	2						90	30		31											29.69	21		21				26.22	16		16												21						16			21			21								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	12	0		29	10	S5715_012_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											45.69	35		35				43.22	30		30												35						30			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	12	0		29	10	S5715_012_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	13	0		29	10	S5715_013_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	13	0		29	10	S5715_013_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								9		27					4		12													27						12				9				9			0.3	0.13				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	13	0		29	10	S5715_013_0	2	Preferred Brand	2	11	1	1	3	1		110	1		100	1				30		90	1	2						90	30		31											30.39	19		19				23.27	14		14												19						14			19			19								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	13	0		29	10	S5715_013_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											43.13	30		30				34.86	25		25												30						25			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	13	0		29	10	S5715_013_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	14	0		29	10	S5715_014_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	14	0		29	10	S5715_014_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								9		27					4		12													27						12				9				9			0.3	0.13				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	14	0		29	10	S5715_014_0	2	Preferred Brand	2	11	1	1	3	1		110	1		100	1				30		90	1	2						90	30		31											29.35	19		19				22.25	14		14												19						14			19			19								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	14	0		29	10	S5715_014_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											39.14	30		30				32.11	25		25												30						25			30			30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	14	0		29	10	S5715_014_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	15	0		29	10	S5715_015_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	15	0		29	10	S5715_015_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								9		27					4		12													27						12				9				9			0.3	0.13				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	15	0		29	10	S5715_015_0	2	Preferred Brand	2	11	1	1	3	1		110	1		100	1				30		90	1	2						90	30		31											32.33	21		21				25.7	16		16												21						16			21			21								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	15	0		29	10	S5715_015_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	1	2						90	30		31											41.43	34		34				31.05	29		29												34						29			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5715	15	0		29	10	S5715_015_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	13	0		29	10	S5726_013_0	3	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								11	22	33					1	2	3					1	2	3																11				11			0.37	0.03	0.03			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	13	0		29	10	S5726_013_0	3	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								13	26	39					3	6	9					3	6	9																13				13			0.43	0.1	0.1			0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	13	0		29	10	S5726_013_0	3	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								43	86	129					33	66	99					33	66	99																43				43			1.43	1.1	1.1			1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	13	0		29	10	S5726_013_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											74.96	50	50	50				61.47	41	41	41				41	41	41															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	13	0		29	10	S5726_013_0	3	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	14	0		29	10	S5726_014_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	14	0		29	10	S5726_014_0	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5726	14	0		29	10	S5726_014_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								17	34	51					3	6	9					3	6	9																17				17			0.57	0.1	0.1			0.5	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	14	0		29	10	S5726_014_0	4	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	14	0		29	10	S5726_014_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											59.92	50	50	50				50.33	42	42	42				42	42	42															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	14	0		29	10	S5726_014_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												33							33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	19	0		29	10	S5726_019_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	19	0		29	10	S5726_019_0	3	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5726	19	0		29	10	S5726_019_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	19	0		29	10	S5726_019_0	3	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5726	19	0		29	10	S5726_019_0	3	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											21.44	22	22	22				19.49	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	19	0		29	10	S5726_019_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											60.48	39	39	39				57.38	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5726	19	0		29	10	S5726_019_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	1	0		29	10	S5743_001_0	4	Preferred Generic	3	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	30					3	6	6											15	30	30				3	6	6				15				15			0.5	0.1		0.5	0.1	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	1	0		29	10	S5743_001_0	4	Generic	3	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	40					8	16	16											20	40	40				8	16	16				20				20			0.67	0.27		0.67	0.27	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	1	0		29	10	S5743_001_0	4	Preferred Brand	3	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								46	92	138					29	58	87											46	92	138				29	58	87				46				46			1.53	0.97		1.53	0.97	1.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	1	0		29	10	S5743_001_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											97.2	35	35	35				56.65	29	29	29										35	35	35				29	29	29			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	1	0		29	10	S5743_001_0	4	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	4	0		29	10	S5743_004_0	3	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	30					0	0	0											15	30	30				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	4	0		29	10	S5743_004_0	3	Preferred Generic	4	11	1	2	1	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	30					0	0	0											15	30	30				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5743	4	0		29	10	S5743_004_0	3	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	40					0	0	0											20	40	40				0	0	0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	4	0		29	10	S5743_004_0	3	Generic	4	11	1	2	2	3		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	40					0	0	0											20	40	40				0	0	0				20				20			0.67	0		0.67	0	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5743	4	0		29	10	S5743_004_0	3	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											24.67	25	25	25				18.12	17	17	17										25	25	25				17	17	17			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	4	0		29	10	S5743_004_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											98.01	45	45	45				60.78	40	40	40										45	45	45				40	40	40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5743	4	0		29	10	S5743_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	6	0		29	10	S5753_006_0	2	Preferred Generic	2	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								7	14	21					2	4	6											7	14	17.5				2	4	5					7			2			0.23	0.07		0.23	0.07	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	6	0		29	10	S5753_006_0	2	Generic	2	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								20	40	60					15	30	45											20	40	50				15	30	37.5					20			15			0.67	0.5		0.67	0.5	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	6	0		29	10	S5753_006_0	2	Preferred Brand	2	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47	94	141					42	84	126											47	94	117.5				42	84	105					47			42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	6	0		29	10	S5753_006_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											68.04	50	50	50				68.04	45	45	45										50	50	50				45	45	45				50		45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	6	0		29	10	S5753_006_0	2	Specialty Tier	2	11	1	1	5	1		10	10		10	1				30								30				29	31											400.69	25						400.69	25												25						25						25		25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	7	0		29	10	S5753_007_0	2	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5	10	15					0	0	0											5	10	12.5				0	0	0					5			0			0.17	0		0.17	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	7	0		29	10	S5753_007_0	2	Preferred Generic	4	1	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5	10	15					0	0	0											5	10	12.5				0	0	0					5			0			0.17	0		0.17	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5753	7	0		29	10	S5753_007_0	2	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16	32	48					11	22	33											16	32	40				11	22	27.5					16			11			0.53	0.37		0.53	0.37	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	7	0		29	10	S5753_007_0	2	Generic	4	1	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16	32	48					11	22	33											16	32	40				11	22	27.5					16			11			0.53	0.37		0.53	0.37	0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5753	7	0		29	10	S5753_007_0	2	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47	94	141					42	84	126											47	94	117.5				42	84	105					47			42			1.57	1.4		1.57	1.4	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	7	0		29	10	S5753_007_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											76.62	50	50	50				76.62	45	45	45										50	50	50				45	45	45				50		45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5753	7	0		29	10	S5753_007_0	2	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				29	31											381.01	33						381.01	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	125	0		29	10	S5768_125_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	125	0		29	10	S5768_125_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	125	0		29	10	S5768_125_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											86.4	50		50				86.4	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	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	126	0		29	10	S5768_126_0	4	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	126	0		29	10	S5768_126_0	4	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	126	0		29	10	S5768_126_0	4	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	4	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											88	47		47				88	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	126	0		29	10	S5768_126_0	4	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	127	0		29	10	S5768_127_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	127	0		29	10	S5768_127_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	127	0		29	10	S5768_127_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											90.34	48		48				90.34	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	127	0		29	10	S5768_127_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	128	0		29	10	S5768_128_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	128	0		29	10	S5768_128_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	128	0		29	10	S5768_128_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											83.61	47		47				83.61	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	128	0		29	10	S5768_128_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	129	0		29	10	S5768_129_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	129	0		29	10	S5768_129_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	129	0		29	10	S5768_129_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											87.17	50		50				87.17	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	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	130	0		29	10	S5768_130_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	130	0		29	10	S5768_130_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	130	0		29	10	S5768_130_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.06	49		49				84.06	49		49										49		49				49		49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	130	0		29	10	S5768_130_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	131	0		29	10	S5768_131_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	131	0		29	10	S5768_131_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	131	0		29	10	S5768_131_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											82.48	47		47				82.48	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	131	0		29	10	S5768_131_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	132	0		29	10	S5768_132_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	132	0		29	10	S5768_132_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	132	0		29	10	S5768_132_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.77	47		47				81.77	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	132	0		29	10	S5768_132_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	133	0		29	10	S5768_133_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	133	0		29	10	S5768_133_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	133	0		29	10	S5768_133_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											87.76	49		49				87.76	49		49										49		49				49		49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	133	0		29	10	S5768_133_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	134	0		29	10	S5768_134_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	134	0		29	10	S5768_134_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	134	0		29	10	S5768_134_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											82.19	47		47				82.19	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	134	0		29	10	S5768_134_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	135	0		29	10	S5768_135_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	135	0		29	10	S5768_135_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	135	0		29	10	S5768_135_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.32	45		45				81.32	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	135	0		29	10	S5768_135_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	136	0		29	10	S5768_136_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	136	0		29	10	S5768_136_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	136	0		29	10	S5768_136_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											78.07	45		45				78.07	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	136	0		29	10	S5768_136_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	137	0		29	10	S5768_137_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	137	0		29	10	S5768_137_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	137	0		29	10	S5768_137_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.14	47		47				81.14	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	137	0		29	10	S5768_137_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	138	0		29	10	S5768_138_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	138	0		29	10	S5768_138_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	138	0		29	10	S5768_138_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	138	0		29	10	S5768_138_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.59	46		46				81.59	46		46										46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	138	0		29	10	S5768_138_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	139	0		29	10	S5768_139_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	139	0		29	10	S5768_139_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	139	0		29	10	S5768_139_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											80.62	45		45				80.62	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	139	0		29	10	S5768_139_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	140	0		29	10	S5768_140_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	140	0		29	10	S5768_140_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	140	0		29	10	S5768_140_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											80.58	47		47				80.58	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	140	0		29	10	S5768_140_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	141	0		29	10	S5768_141_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	141	0		29	10	S5768_141_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	141	0		29	10	S5768_141_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											91.29	50		50				91.29	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	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	142	0		29	10	S5768_142_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	142	0		29	10	S5768_142_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	142	0		29	10	S5768_142_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											77.95	46		46				77.95	46		46										46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	142	0		29	10	S5768_142_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	143	0		29	10	S5768_143_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	143	0		29	10	S5768_143_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	143	0		29	10	S5768_143_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.91	49		49				81.91	49		49										49		49				49		49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	143	0		29	10	S5768_143_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	144	0		29	10	S5768_144_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	144	0		29	10	S5768_144_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	144	0		29	10	S5768_144_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											85.6	49		49				85.6	49		49										49		49				49		49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	144	0		29	10	S5768_144_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	145	0		29	10	S5768_145_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	145	0		29	10	S5768_145_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	145	0		29	10	S5768_145_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											82.67	46		46				82.67	46		46										46		46				46		46			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	145	0		29	10	S5768_145_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	146	0		29	10	S5768_146_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	146	0		29	10	S5768_146_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	146	0		29	10	S5768_146_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	146	0		29	10	S5768_146_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											91.71	48		48				91.71	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	146	0		29	10	S5768_146_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	147	0		29	10	S5768_147_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	147	0		29	10	S5768_147_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	147	0		29	10	S5768_147_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											89.49	50		50				89.49	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	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	148	0		29	10	S5768_148_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	148	0		29	10	S5768_148_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	148	0		29	10	S5768_148_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											90.32	50		50				90.32	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	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	149	0		29	10	S5768_149_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	149	0		29	10	S5768_149_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	149	0		29	10	S5768_149_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.27	44		44				74.27	44		44										44		44				44		44			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	149	0		29	10	S5768_149_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	150	0		29	10	S5768_150_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	150	0		29	10	S5768_150_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	150	0		29	10	S5768_150_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											88.03	45		45				88.03	45		45										45		45				45		45			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	150	0		29	10	S5768_150_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	151	0		29	10	S5768_151_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	151	0		29	10	S5768_151_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	151	0		29	10	S5768_151_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.37	48		48				84.37	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	151	0		29	10	S5768_151_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	152	0		29	10	S5768_152_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	152	0		29	10	S5768_152_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	152	0		29	10	S5768_152_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											76.91	42		42				76.91	42		42										42		42				42		42			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	152	0		29	10	S5768_152_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	153	0		29	10	S5768_153_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	153	0		29	10	S5768_153_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	153	0		29	10	S5768_153_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											87.26	48		48				87.26	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	153	0		29	10	S5768_153_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	154	0		29	10	S5768_154_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	154	0		29	10	S5768_154_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	154	0		29	10	S5768_154_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.18	49		49				84.18	49		49										49		49				49		49			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	154	0		29	10	S5768_154_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	155	0		29	10	S5768_155_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	155	0		29	10	S5768_155_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	155	0		29	10	S5768_155_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											94.15	48		48				94.15	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	155	0		29	10	S5768_155_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	197	0		29	10	S5768_197_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	197	0		29	10	S5768_197_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	197	0		29	10	S5768_197_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	197	0		29	10	S5768_197_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											97.85	48		48				97.85	48		48										48		48				48		48			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	197	0		29	10	S5768_197_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	198	0		29	10	S5768_198_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	198	0		29	10	S5768_198_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	198	0		29	10	S5768_198_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											87.95	47		47				87.95	47		47										47		47				47		47			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	198	0		29	10	S5768_198_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	200	0		29	10	S5768_200_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		0				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	200	0		29	10	S5768_200_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					4		12											20		60				4		10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	200	0		29	10	S5768_200_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			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	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											88.54	43		43				88.54	43		43										43		43				43		43			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5768	200	0		29	10	S5768_200_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5795	2	0		29	10	S5795_002_0	5	Preferred Generic	4	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								10		25					2		5					2		5																10				2			0.33	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5795	2	0		29	10	S5795_002_0	5	Preferred Generic	4	1	1	2	1	3		110	1	110		1				30		90	1	2	30		90				30		31								10		25					2		5					2		5																10				2			0.33	0.07	0.07			0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5795	2	0		29	10	S5795_002_0	5	Generic	4	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					8		20					8		20																20				8			0.67	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5795	2	0		29	10	S5795_002_0	5	Generic	4	1	1	2	2	3		110	1	110		1				30		90	1	2	30		90				30		31								20		50					8		20					8		20																20				8			0.67	0.27	0.27			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5795	2	0		29	10	S5795_002_0	5	Preferred Brand	4	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		117.5					40		100					40		100																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5795	2	0		29	10	S5795_002_0	5	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				30		90	1	2	30		90				30		31								100		250					90		225					90		225																100				90			3.33	3	3			2.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5795	2	0		29	10	S5795_002_0	5	Specialty Tier	4	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	33		33				1	33		33				33		33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5795	3	0		29	10	S5795_003_0	5	Preferred Generic	3	1	1	2	1	1		110	1	110		1				30		90	1	2	30		90				30		31								11		27.5					3		7.5					3		7.5																11				3			0.37	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5795	3	0		29	10	S5795_003_0	5	Generic	3	1	1	2	2	1		110	1	110		1				30		90	1	2	30		90				30		31								20		50					6		15					6		15																20				6			0.67	0.2	0.2			0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5795	3	0		29	10	S5795_003_0	5	Preferred Brand	3	11	1	2	3	1		110	1	110		1				30		90	1	2	30		90				30		31								47		117.5					40		100					40		100																47				40			1.57	1.33	1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5795	3	0		29	10	S5795_003_0	5	Non-Preferred Drug	3	11	1	1	4	1		110	1	110		1				30		90	1	2	30		90				30		31											86.84	50		50				76.77	48		48				48		48															50			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5795	3	0		29	10	S5795_003_0	5	Specialty Tier	3	11	1	1	5	1		110	1	110		1				30		90	1	2	30		90				30		31											1	25		25				1	25		25				25		25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5805	1	0		29	10	S5805_001_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5805	1	0		29	10	S5805_001_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5805	1	0		29	10	S5805_001_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5805	1	0		29	10	S5805_001_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											93	45		45				82	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5805	1	0		29	10	S5805_001_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1047	33		33				915	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	35	0		29	10	S5810_035_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	35	0		29	10	S5810_035_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	35	0		29	10	S5810_035_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					30		90											40		120				30		75				40				40			1.33	1		1.33	1	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	35	0		29	10	S5810_035_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											85.35	45		45				75.86	40		40										45		45				40		40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	35	0		29	10	S5810_035_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	36	0		29	10	S5810_036_0	4	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	36	0		29	10	S5810_036_0	4	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	36	0		29	10	S5810_036_0	4	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	36	0		29	10	S5810_036_0	4	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											85.15	44		44				73.54	38		38										44		44				38		38			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	36	0		29	10	S5810_036_0	4	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	37	0		29	10	S5810_037_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	37	0		29	10	S5810_037_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	37	0		29	10	S5810_037_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								38		114					27		81											38		114				27		67.5				38				38			1.27	0.9		1.27	0.9	1.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	37	0		29	10	S5810_037_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											85.29	40		40				76.76	36		36										40		40				36		36			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	37	0		29	10	S5810_037_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	38	0		29	10	S5810_038_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	38	0		29	10	S5810_038_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	38	0		29	10	S5810_038_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	38	0		29	10	S5810_038_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											86.12	42		42				77.92	38		38										42		42				38		38			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	38	0		29	10	S5810_038_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	39	0		29	10	S5810_039_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	39	0		29	10	S5810_039_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	39	0		29	10	S5810_039_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	39	0		29	10	S5810_039_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.16	42		42				73.43	38		38										42		42				38		38			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	39	0		29	10	S5810_039_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	40	0		29	10	S5810_040_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	40	0		29	10	S5810_040_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	40	0		29	10	S5810_040_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					29		87											40		120				29		72.5				40				40			1.33	0.97		1.33	0.97	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	40	0		29	10	S5810_040_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.36	45		45				72.32	40		40										45		45				40		40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	40	0		29	10	S5810_040_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	41	0		29	10	S5810_041_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	41	0		29	10	S5810_041_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	41	0		29	10	S5810_041_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	41	0		29	10	S5810_041_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.29	45		45				73.05	39		39										45		45				39		39			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	41	0		29	10	S5810_041_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	42	0		29	10	S5810_042_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	42	0		29	10	S5810_042_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	42	0		29	10	S5810_042_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	42	0		29	10	S5810_042_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											88.56	44		44				74.47	37		37										44		44				37		37			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	42	0		29	10	S5810_042_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	43	0		29	10	S5810_043_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	43	0		29	10	S5810_043_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	43	0		29	10	S5810_043_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	43	0		29	10	S5810_043_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.72	43		43				74.12	39		39										43		43				39		39			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	43	0		29	10	S5810_043_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	44	0		29	10	S5810_044_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	44	0		29	10	S5810_044_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	44	0		29	10	S5810_044_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	44	0		29	10	S5810_044_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											79.24	42		42				71.69	38		38										42		42				38		38			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	44	0		29	10	S5810_044_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	45	0		29	10	S5810_045_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	45	0		29	10	S5810_045_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	45	0		29	10	S5810_045_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	45	0		29	10	S5810_045_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											70.76	45		45				58.18	37		37										45		45				37		37			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	45	0		29	10	S5810_045_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	46	0		29	10	S5810_046_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	46	0		29	10	S5810_046_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	46	0		29	10	S5810_046_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	46	0		29	10	S5810_046_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.25	44		44				68.32	37		37										44		44				37		37			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	46	0		29	10	S5810_046_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	47	0		29	10	S5810_047_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	47	0		29	10	S5810_047_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	47	0		29	10	S5810_047_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	47	0		29	10	S5810_047_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.58	40		40				65.26	35		35										40		40				35		35			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	47	0		29	10	S5810_047_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	48	0		29	10	S5810_048_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	48	0		29	10	S5810_048_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	48	0		29	10	S5810_048_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	48	0		29	10	S5810_048_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											87.32	45		45				75.67	39		39										45		45				39		39			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	48	0		29	10	S5810_048_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	49	0		29	10	S5810_049_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	49	0		29	10	S5810_049_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	49	0		29	10	S5810_049_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								42		126					28		84											42		126				28		70				42				42			1.4	0.93		1.4	0.93	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	49	0		29	10	S5810_049_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											88.34	45		45				76.56	39		39										45		45				39		39			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	49	0		29	10	S5810_049_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	50	0		29	10	S5810_050_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	50	0		29	10	S5810_050_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	50	0		29	10	S5810_050_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								35		105					28		84											35		105				28		70				35				35			1.17	0.93		1.17	0.93	1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	50	0		29	10	S5810_050_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											75.15	40		40				69.51	37		37										40		40				37		37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	50	0		29	10	S5810_050_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	51	0		29	10	S5810_051_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	51	0		29	10	S5810_051_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	51	0		29	10	S5810_051_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					28		84											45		135				28		70				45				45			1.5	0.93		1.5	0.93	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	51	0		29	10	S5810_051_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											76.96	45		45				68.41	40		40										45		45				40		40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	51	0		29	10	S5810_051_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	52	0		29	10	S5810_052_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	52	0		29	10	S5810_052_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	52	0		29	10	S5810_052_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								33		99					28		84											33		99				28		70				33				33			1.1	0.93		1.1	0.93	1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	52	0		29	10	S5810_052_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											80.13	40		40				74.12	37		37										40		40				37		37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	52	0		29	10	S5810_052_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	53	0		29	10	S5810_053_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	53	0		29	10	S5810_053_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	53	0		29	10	S5810_053_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	53	0		29	10	S5810_053_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											71.35	42		42				62.85	37		37										42		42				37		37			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	53	0		29	10	S5810_053_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	54	0		29	10	S5810_054_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	54	0		29	10	S5810_054_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	54	0		29	10	S5810_054_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	54	0		29	10	S5810_054_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											85.21	45		45				71.95	38		38										45		45				38		38			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	54	0		29	10	S5810_054_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	55	0		29	10	S5810_055_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	55	0		29	10	S5810_055_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	55	0		29	10	S5810_055_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	55	0		29	10	S5810_055_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											73.93	40		40				68.38	37		37										40		40				37		37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	55	0		29	10	S5810_055_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	56	0		29	10	S5810_056_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	56	0		29	10	S5810_056_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	56	0		29	10	S5810_056_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								42		126					28		84											42		126				28		70				42				42			1.4	0.93		1.4	0.93	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	56	0		29	10	S5810_056_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.67	45		45				73.38	39		39										45		45				39		39			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	56	0		29	10	S5810_056_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	57	0		29	10	S5810_057_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	57	0		29	10	S5810_057_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	57	0		29	10	S5810_057_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	57	0		29	10	S5810_057_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											79.34	45		45				65.24	37		37										45		45				37		37			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	57	0		29	10	S5810_057_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	58	0		29	10	S5810_058_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	58	0		29	10	S5810_058_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	58	0		29	10	S5810_058_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	58	0		29	10	S5810_058_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											77.75	42		42				66.64	36		36										42		42				36		36			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	58	0		29	10	S5810_058_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	59	0		29	10	S5810_059_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	59	0		29	10	S5810_059_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	59	0		29	10	S5810_059_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	59	0		29	10	S5810_059_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											78.1	45		45				65.95	38		38										45		45				38		38			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	59	0		29	10	S5810_059_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	60	0		29	10	S5810_060_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	60	0		29	10	S5810_060_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	60	0		29	10	S5810_060_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								42		126					28		84											42		126				28		70				42				42			1.4	0.93		1.4	0.93	1.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	60	0		29	10	S5810_060_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											66.39	45		45				59.02	40		40										45		45				40		40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	60	0		29	10	S5810_060_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	61	0		29	10	S5810_061_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	61	0		29	10	S5810_061_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	61	0		29	10	S5810_061_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	61	0		29	10	S5810_061_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											79.37	45		45				67.03	38		38										45		45				38		38			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	61	0		29	10	S5810_061_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	62	0		29	10	S5810_062_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	62	0		29	10	S5810_062_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					2		6											10		30				2		5				10				10			0.33	0.07		0.33	0.07	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	62	0		29	10	S5810_062_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					28		84											45		135				28		70				45				45			1.5	0.93		1.5	0.93	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	62	0		29	10	S5810_062_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											80.23	45		45				71.32	40		40										45		45				40		40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	62	0		29	10	S5810_062_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	63	0		29	10	S5810_063_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	63	0		29	10	S5810_063_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	63	0		29	10	S5810_063_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								41		123					28		84											41		123				28		70				41				41			1.37	0.93		1.37	0.93	1.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	63	0		29	10	S5810_063_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											86.75	45		45				75.19	39		39										45		45				39		39			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	63	0		29	10	S5810_063_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	64	0		29	10	S5810_064_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	64	0		29	10	S5810_064_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	64	0		29	10	S5810_064_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					28		84											40		120				28		70				40				40			1.33	0.93		1.33	0.93	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	64	0		29	10	S5810_064_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.51	45		45				62.92	38		38										45		45				38		38			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	64	0		29	10	S5810_064_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	65	0		29	10	S5810_065_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	65	0		29	10	S5810_065_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								6		18					2		6											6		18				2		5				6				6			0.2	0.07		0.2	0.07	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	65	0		29	10	S5810_065_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					30		90											40		120				30		75				40				40			1.33	1		1.33	1	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	65	0		29	10	S5810_065_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											76.05	41		41				68.63	37		37										41		41				37		37			41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	65	0		29	10	S5810_065_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	66	0		29	10	S5810_066_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								2		6					0		0											2		6				0		0				2				2			0.07	0		0.07	0	0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	66	0		29	10	S5810_066_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					2		6											5		15				2		5				5				5			0.17	0.07		0.17	0.07	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	66	0		29	10	S5810_066_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								40		120					30		90											40		120				30		75				40				40			1.33	1		1.33	1	1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	66	0		29	10	S5810_066_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											82.73	40		40				76.53	37		37										40		40				37		37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	66	0		29	10	S5810_066_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	67	0		29	10	S5810_067_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	67	0		29	10	S5810_067_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								6		18					3		9											6		18				3		7.5				6				6			0.2	0.1		0.2	0.1	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	67	0		29	10	S5810_067_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								45		135					34		102											45		135				34		85				45				45			1.5	1.13		1.5	1.13	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	67	0		29	10	S5810_067_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											98.58	43		43				87.12	38		38										43		43				38		38			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	67	0		29	10	S5810_067_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	68	0		29	10	S5810_068_0	3	Preferred Generic	2	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								3		9					0		0											3		9				0		0				3				3			0.1	0		0.1	0	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	68	0		29	10	S5810_068_0	3	Generic	2	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								12		36					3		9											12		36				3		7.5				12				12			0.4	0.1		0.4	0.1	0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	68	0		29	10	S5810_068_0	3	Preferred Brand	2	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					35		105											47		141				35		87.5				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	68	0		29	10	S5810_068_0	3	Non-Preferred Drug	2	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											99.82	50		50				79.86	40		40										50		50				40		40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	68	0		29	10	S5810_068_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	276	0		29	10	S5810_276_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	276	0		29	10	S5810_276_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	276	0		29	10	S5810_276_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	276	0		29	10	S5810_276_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.59	49		49				69.94	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	276	0		29	10	S5810_276_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	277	0		29	10	S5810_277_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	277	0		29	10	S5810_277_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	277	0		29	10	S5810_277_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	277	0		29	10	S5810_277_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											98.79	47		47				88.28	42		42										47		47				42		42			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	277	0		29	10	S5810_277_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	278	0		29	10	S5810_278_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	278	0		29	10	S5810_278_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	278	0		29	10	S5810_278_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	278	0		29	10	S5810_278_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											75.17	49		49				64.43	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	278	0		29	10	S5810_278_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	279	0		29	10	S5810_279_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	279	0		29	10	S5810_279_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	279	0		29	10	S5810_279_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	279	0		29	10	S5810_279_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.3	49		49				69.69	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	279	0		29	10	S5810_279_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	280	0		29	10	S5810_280_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	280	0		29	10	S5810_280_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	280	0		29	10	S5810_280_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	280	0		29	10	S5810_280_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											77.87	49		49				66.75	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	280	0		29	10	S5810_280_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	281	0		29	10	S5810_281_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	281	0		29	10	S5810_281_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	281	0		29	10	S5810_281_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	281	0		29	10	S5810_281_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											69.62	49		49				59.67	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	281	0		29	10	S5810_281_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	282	0		29	10	S5810_282_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	282	0		29	10	S5810_282_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	282	0		29	10	S5810_282_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	282	0		29	10	S5810_282_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											78.34	49		49				67.15	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	282	0		29	10	S5810_282_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												26							26												26						26					26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	283	0		29	10	S5810_283_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	283	0		29	10	S5810_283_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	283	0		29	10	S5810_283_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	283	0		29	10	S5810_283_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											84.36	49		49				72.31	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	283	0		29	10	S5810_283_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	284	0		29	10	S5810_284_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	284	0		29	10	S5810_284_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	284	0		29	10	S5810_284_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	284	0		29	10	S5810_284_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											81.47	49		49				69.83	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	284	0		29	10	S5810_284_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	285	0		29	10	S5810_285_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	285	0		29	10	S5810_285_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	285	0		29	10	S5810_285_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	285	0		29	10	S5810_285_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											78.61	49		49				67.38	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	285	0		29	10	S5810_285_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	286	0		29	10	S5810_286_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	286	0		29	10	S5810_286_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	286	0		29	10	S5810_286_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	286	0		29	10	S5810_286_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											82.57	49		49				70.78	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	286	0		29	10	S5810_286_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	287	0		29	10	S5810_287_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	287	0		29	10	S5810_287_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	287	0		29	10	S5810_287_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	287	0		29	10	S5810_287_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											76.82	49		49				65.84	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	287	0		29	10	S5810_287_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	288	0		29	10	S5810_288_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	288	0		29	10	S5810_288_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	288	0		29	10	S5810_288_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	288	0		29	10	S5810_288_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											73.63	49		49				63.11	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	288	0		29	10	S5810_288_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	289	0		29	10	S5810_289_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	289	0		29	10	S5810_289_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	289	0		29	10	S5810_289_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	289	0		29	10	S5810_289_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.82	49		49				64.14	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	289	0		29	10	S5810_289_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	290	0		29	10	S5810_290_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	290	0		29	10	S5810_290_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	290	0		29	10	S5810_290_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	290	0		29	10	S5810_290_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											75.79	49		49				64.96	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	290	0		29	10	S5810_290_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	291	0		29	10	S5810_291_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	291	0		29	10	S5810_291_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	291	0		29	10	S5810_291_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	291	0		29	10	S5810_291_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.21	49		49				63.61	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	291	0		29	10	S5810_291_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	292	0		29	10	S5810_292_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	292	0		29	10	S5810_292_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	292	0		29	10	S5810_292_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	292	0		29	10	S5810_292_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											78.23	49		49				67.06	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	292	0		29	10	S5810_292_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	293	0		29	10	S5810_293_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	293	0		29	10	S5810_293_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	293	0		29	10	S5810_293_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	293	0		29	10	S5810_293_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											83.45	49		49				71.53	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	293	0		29	10	S5810_293_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	294	0		29	10	S5810_294_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	294	0		29	10	S5810_294_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	294	0		29	10	S5810_294_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	294	0		29	10	S5810_294_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											64.86	49		49				55.59	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	294	0		29	10	S5810_294_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	295	0		29	10	S5810_295_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	295	0		29	10	S5810_295_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	295	0		29	10	S5810_295_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	295	0		29	10	S5810_295_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											87.83	49		49				75.28	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	295	0		29	10	S5810_295_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	296	0		29	10	S5810_296_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	296	0		29	10	S5810_296_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	296	0		29	10	S5810_296_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	296	0		29	10	S5810_296_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											77.55	49		49				66.47	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	296	0		29	10	S5810_296_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	297	0		29	10	S5810_297_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	297	0		29	10	S5810_297_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	297	0		29	10	S5810_297_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	297	0		29	10	S5810_297_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											75.14	49		49				64.41	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	297	0		29	10	S5810_297_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												27							27												27						27					27			27								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	298	0		29	10	S5810_298_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	298	0		29	10	S5810_298_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	298	0		29	10	S5810_298_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	298	0		29	10	S5810_298_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											80.17	49		49				68.71	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	298	0		29	10	S5810_298_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	299	0		29	10	S5810_299_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	299	0		29	10	S5810_299_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	299	0		29	10	S5810_299_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	299	0		29	10	S5810_299_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											82.58	49		49				70.78	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	299	0		29	10	S5810_299_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	300	0		29	10	S5810_300_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	300	0		29	10	S5810_300_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	300	0		29	10	S5810_300_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	300	0		29	10	S5810_300_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											78.54	49		49				67.32	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	300	0		29	10	S5810_300_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	301	0		29	10	S5810_301_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	301	0		29	10	S5810_301_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	301	0		29	10	S5810_301_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	301	0		29	10	S5810_301_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.18	49		49				63.58	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	301	0		29	10	S5810_301_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	302	0		29	10	S5810_302_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	302	0		29	10	S5810_302_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	302	0		29	10	S5810_302_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	302	0		29	10	S5810_302_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.54	49		49				63.89	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	302	0		29	10	S5810_302_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	303	0		29	10	S5810_303_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	303	0		29	10	S5810_303_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	303	0		29	10	S5810_303_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	303	0		29	10	S5810_303_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											86.97	49		49				74.55	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	303	0		29	10	S5810_303_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	304	0		29	10	S5810_304_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	304	0		29	10	S5810_304_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	304	0		29	10	S5810_304_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	304	0		29	10	S5810_304_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.86	49		49				64.16	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	304	0		29	10	S5810_304_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	305	0		29	10	S5810_305_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	305	0		29	10	S5810_305_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	305	0		29	10	S5810_305_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	305	0		29	10	S5810_305_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											77.83	49		49				66.71	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	305	0		29	10	S5810_305_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	306	0		29	10	S5810_306_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	306	0		29	10	S5810_306_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	306	0		29	10	S5810_306_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	306	0		29	10	S5810_306_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											75.42	49		49				64.65	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	306	0		29	10	S5810_306_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	307	0		29	10	S5810_307_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	307	0		29	10	S5810_307_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	307	0		29	10	S5810_307_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	307	0		29	10	S5810_307_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											74.74	49		49				64.06	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	307	0		29	10	S5810_307_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	308	0		29	10	S5810_308_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	308	0		29	10	S5810_308_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	308	0		29	10	S5810_308_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	308	0		29	10	S5810_308_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											83.68	49		49				71.73	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	308	0		29	10	S5810_308_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	309	0		29	10	S5810_309_0	3	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								15		45					0		0											15		45				0		0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	309	0		29	10	S5810_309_0	3	Generic	4	11	1	2	2	1		110	1		110	1				30		90	1	2				30		90	30		31								20		60					3		9											20		60				3		7.5				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	309	0		29	10	S5810_309_0	3	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	1	2				30		90	30		31								47		141					47		141											47		141				47		117.5				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	309	0		29	10	S5810_309_0	3	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	1	2				30		90	30		31											85.57	49		49				73.34	42		42										49		49				42		42			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5810	309	0		29	10	S5810_309_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	1	0		29	10	S5820_001_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	1	0		29	10	S5820_001_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	1	0		29	10	S5820_001_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	1	0		29	10	S5820_001_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											67	45		45				66	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	1	0		29	10	S5820_001_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1123	33		33				899	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	2	0		29	10	S5820_002_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	2	0		29	10	S5820_002_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	2	0		29	10	S5820_002_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	2	0		29	10	S5820_002_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											79	45		45				73	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	2	0		29	10	S5820_002_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1057	33		33				966	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	3	0		29	10	S5820_003_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	3	0		29	10	S5820_003_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	3	0		29	10	S5820_003_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	3	0		29	10	S5820_003_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											87	45		45				63	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	3	0		29	10	S5820_003_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1077	33		33				994	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	4	0		29	10	S5820_004_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	4	0		29	10	S5820_004_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	4	0		29	10	S5820_004_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	4	0		29	10	S5820_004_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											88	45		45				66	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	4	0		29	10	S5820_004_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											918	33		33				918	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	5	0		29	10	S5820_005_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	5	0		29	10	S5820_005_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	5	0		29	10	S5820_005_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	5	0		29	10	S5820_005_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											77	45		45				64	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	5	0		29	10	S5820_005_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1201	33		33				1081	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	6	0		29	10	S5820_006_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	6	0		29	10	S5820_006_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	6	0		29	10	S5820_006_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	6	0		29	10	S5820_006_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											89	45		45				67	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	6	0		29	10	S5820_006_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1058	33		33				993	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	7	0		29	10	S5820_007_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	7	0		29	10	S5820_007_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	7	0		29	10	S5820_007_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	7	0		29	10	S5820_007_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											86	45		45				60	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	7	0		29	10	S5820_007_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1164	33		33				1087	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	8	0		29	10	S5820_008_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	8	0		29	10	S5820_008_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	8	0		29	10	S5820_008_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	8	0		29	10	S5820_008_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											75	45		45				64	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	8	0		29	10	S5820_008_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1313	33		33				1170	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	9	0		29	10	S5820_009_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	9	0		29	10	S5820_009_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	9	0		29	10	S5820_009_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	9	0		29	10	S5820_009_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											98	45		45				67	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	9	0		29	10	S5820_009_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1288	33		33				1190	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	10	0		29	10	S5820_010_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	10	0		29	10	S5820_010_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	10	0		29	10	S5820_010_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	10	0		29	10	S5820_010_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											88	45		45				67	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	10	0		29	10	S5820_010_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1179	33		33				1125	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	11	0		29	10	S5820_011_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	11	0		29	10	S5820_011_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	11	0		29	10	S5820_011_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	11	0		29	10	S5820_011_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											94	45		45				63	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	11	0		29	10	S5820_011_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1123	33		33				1085	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	12	0		29	10	S5820_012_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	12	0		29	10	S5820_012_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	12	0		29	10	S5820_012_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	12	0		29	10	S5820_012_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											75	45		45				61	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	12	0		29	10	S5820_012_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1073	33		33				972	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	13	0		29	10	S5820_013_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	13	0		29	10	S5820_013_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	13	0		29	10	S5820_013_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	13	0		29	10	S5820_013_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											78	45		45				69	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	13	0		29	10	S5820_013_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1253	33		33				1115	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	14	0		29	10	S5820_014_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	14	0		29	10	S5820_014_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	14	0		29	10	S5820_014_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	14	0		29	10	S5820_014_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											88	45		45				71	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	14	0		29	10	S5820_014_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1071	33		33				1061	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	15	0		29	10	S5820_015_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	15	0		29	10	S5820_015_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	15	0		29	10	S5820_015_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	15	0		29	10	S5820_015_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											87	45		45				60	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	15	0		29	10	S5820_015_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1219	33		33				1247	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	16	0		29	10	S5820_016_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	16	0		29	10	S5820_016_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	16	0		29	10	S5820_016_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	16	0		29	10	S5820_016_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											89	45		45				66	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	16	0		29	10	S5820_016_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1081	33		33				1004	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	17	0		29	10	S5820_017_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	17	0		29	10	S5820_017_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	17	0		29	10	S5820_017_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	17	0		29	10	S5820_017_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											88	45		45				65	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	17	0		29	10	S5820_017_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											924	33		33				929	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	18	0		29	10	S5820_018_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	18	0		29	10	S5820_018_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	18	0		29	10	S5820_018_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	18	0		29	10	S5820_018_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											75	45		45				59	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	18	0		29	10	S5820_018_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1201	33		33				1306	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	19	0		29	10	S5820_019_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	19	0		29	10	S5820_019_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	19	0		29	10	S5820_019_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	19	0		29	10	S5820_019_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											85	45		45				63	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	19	0		29	10	S5820_019_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1164	33		33				1060	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	20	0		29	10	S5820_020_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	20	0		29	10	S5820_020_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	20	0		29	10	S5820_020_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	20	0		29	10	S5820_020_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											90	45		45				63	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	20	0		29	10	S5820_020_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											979	33		33				984	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	21	0		29	10	S5820_021_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	21	0		29	10	S5820_021_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	21	0		29	10	S5820_021_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	21	0		29	10	S5820_021_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											87	45		45				64	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	21	0		29	10	S5820_021_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1058	33		33				1025	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	22	0		29	10	S5820_022_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	22	0		29	10	S5820_022_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	22	0		29	10	S5820_022_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	22	0		29	10	S5820_022_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											89	45		45				70	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	22	0		29	10	S5820_022_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1084	33		33				1063	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	23	0		29	10	S5820_023_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	23	0		29	10	S5820_023_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	23	0		29	10	S5820_023_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	23	0		29	10	S5820_023_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											81	45		45				66	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	23	0		29	10	S5820_023_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1019	33		33				1066	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	24	0		29	10	S5820_024_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	24	0		29	10	S5820_024_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	24	0		29	10	S5820_024_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	24	0		29	10	S5820_024_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											85	45		45				57	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	24	0		29	10	S5820_024_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1204	33		33				929	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	25	0		29	10	S5820_025_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	25	0		29	10	S5820_025_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	25	0		29	10	S5820_025_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	25	0		29	10	S5820_025_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											92	45		45				58	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	25	0		29	10	S5820_025_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1136	33		33				1104	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	26	0		29	10	S5820_026_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	26	0		29	10	S5820_026_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	26	0		29	10	S5820_026_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	26	0		29	10	S5820_026_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											76	45		45				66	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	26	0		29	10	S5820_026_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1065	33		33				1099	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	27	0		29	10	S5820_027_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	27	0		29	10	S5820_027_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	27	0		29	10	S5820_027_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	27	0		29	10	S5820_027_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											97	45		45				64	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	27	0		29	10	S5820_027_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1165	33		33				1156	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	28	0		29	10	S5820_028_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	28	0		29	10	S5820_028_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	28	0		29	10	S5820_028_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	28	0		29	10	S5820_028_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											92	45		45				63	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	28	0		29	10	S5820_028_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											985	33		33				1053	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	29	0		29	10	S5820_029_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	29	0		29	10	S5820_029_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	29	0		29	10	S5820_029_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	29	0		29	10	S5820_029_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											89	45		45				65	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	29	0		29	10	S5820_029_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1261	33		33				1179	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	30	0		29	10	S5820_030_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	30	0		29	10	S5820_030_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	30	0		29	10	S5820_030_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	30	0		29	10	S5820_030_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											79	45		45				59	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	30	0		29	10	S5820_030_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1514	33		33				1232	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	31	0		29	10	S5820_031_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	31	0		29	10	S5820_031_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	31	0		29	10	S5820_031_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	31	0		29	10	S5820_031_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											85	45		45				63	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	31	0		29	10	S5820_031_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											923	33		33				844	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	32	0		29	10	S5820_032_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	32	0		29	10	S5820_032_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	32	0		29	10	S5820_032_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	32	0		29	10	S5820_032_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											86	45		45				59	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	32	0		29	10	S5820_032_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											749	33		33				780	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	33	0		29	10	S5820_033_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					5		15													45						0				15				15			0.5	0.16				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	33	0		29	10	S5820_033_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					10		30													60						0				20				20			0.66	0.33				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	33	0		29	10	S5820_033_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					45		135													141						120				47				47			1.56	1.5				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	33	0		29	10	S5820_033_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											73	45		45				77	40		40												45						40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	33	0		29	10	S5820_033_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											981	33		33				1156	33		33												33						33			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	34	0		29	10	S5820_034_0	2	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	1		3																					3																1				1		0.03						0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	34	0		29	10	S5820_034_0	2	Generic	2	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	12		36																					36																12				12		0.4						0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	34	0		29	10	S5820_034_0	2	Preferred Brand	2	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	25		75																					75																25				25		0.83						0.8	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	34	0		29	10	S5820_034_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				68	42		42																				42															42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	34	0		29	10	S5820_034_0	2	Specialty Tier	2	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31				959	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	35	0		29	10	S5820_035_0	2	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	1		3																					3																1				1		0.03						0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	35	0		29	10	S5820_035_0	2	Generic	2	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	16		48																					48																16				16		0.53						0.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	35	0		29	10	S5820_035_0	2	Preferred Brand	2	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	26		78																					78																26				26		0.86						0.83	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	35	0		29	10	S5820_035_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				98	40		40																				40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	35	0		29	10	S5820_035_0	2	Specialty Tier	2	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31				1643	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	36	0		29	10	S5820_036_0	1	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	1		3																					3																1				1		0.03						0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	36	0		29	10	S5820_036_0	1	Generic	2	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	20		60																					60																20				20		0.66						0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	36	0		29	10	S5820_036_0	1	Preferred Brand	2	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	26		78																					78																26				26		0.86						0.83	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	36	0		29	10	S5820_036_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				86	43		43																				43															43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	36	0		29	10	S5820_036_0	1	Specialty Tier	2	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31				925	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	37	0		29	10	S5820_037_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								2		6					1		3													6						3				2				2			0.06	0.03				0.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	37	0		29	10	S5820_037_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	37	0		29	10	S5820_037_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	37	0		29	10	S5820_037_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											78	50		50				66	40		40												50						40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	37	0		29	10	S5820_037_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1150	25		25				1105	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	38	0		29	10	S5820_038_0	2	Preferred Generic	2	1	1	2	1	1	110		1	100		1	30		90				2	2			90				30		31	1		3																					3																1				1		0.03						0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	38	0		29	10	S5820_038_0	2	Generic	2	1	1	2	2	1	110		1	100		1	30		90				2	2			90				30		31	19		57																					57																19				19		0.63						0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	38	0		29	10	S5820_038_0	2	Preferred Brand	2	11	1	2	3	1	110		1	100		1	30		90				2	2			90				30		31	25		75																					75																25				25		0.83						0.8	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	38	0		29	10	S5820_038_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		1	100		1	30		90				2	2			90				30		31				69	44		44																				44															44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5820	38	0		29	10	S5820_038_0	2	Specialty Tier	2	11	1	1	5	1	110		1	100		1	30		90				2	2			90				30		31				832	25		25																				25															25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	101	0		29	10	S5884_101_0	2	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	101	0		29	10	S5884_101_0	2	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	101	0		29	10	S5884_101_0	2	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	101	0		29	10	S5884_101_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				56	37		37																								37		37				37		30			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	101	0		29	10	S5884_101_0	2	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	102	0		29	10	S5884_102_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	102	0		29	10	S5884_102_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	102	0		29	10	S5884_102_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	102	0		29	10	S5884_102_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				58	35		35																								35		35				35		30			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	102	0		29	10	S5884_102_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	103	0		29	10	S5884_103_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	103	0		29	10	S5884_103_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	103	0		29	10	S5884_103_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				36	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	103	0		29	10	S5884_103_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				59	38		38																								38		38				38		30			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	103	0		29	10	S5884_103_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	104	0		29	10	S5884_104_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	104	0		29	10	S5884_104_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	104	0		29	10	S5884_104_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				35	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	104	0		29	10	S5884_104_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				60	39		39																								39		39				39		30			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	104	0		29	10	S5884_104_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	105	0		29	10	S5884_105_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	105	0		29	10	S5884_105_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	105	0		29	10	S5884_105_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				32	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	105	0		29	10	S5884_105_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				61	40		40																								40		40				40		30			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	105	0		29	10	S5884_105_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	106	0		29	10	S5884_106_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	106	0		29	10	S5884_106_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	106	0		29	10	S5884_106_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				29	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	106	0		29	10	S5884_106_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				62	40		40																								40		40				40		30			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	106	0		29	10	S5884_106_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	107	0		29	10	S5884_107_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	107	0		29	10	S5884_107_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	107	0		29	10	S5884_107_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	107	0		29	10	S5884_107_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				58	40		40																								40		40				40		30			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	107	0		29	10	S5884_107_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					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	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	108	0		29	10	S5884_108_0	2	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	108	0		29	10	S5884_108_0	2	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		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	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				58	38		38																								38		38				38		30			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	108	0		29	10	S5884_108_0	2	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	109	0		29	10	S5884_109_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	109	0		29	10	S5884_109_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	109	0		29	10	S5884_109_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				28	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	109	0		29	10	S5884_109_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				56	40		40																								40		40				40		30			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	109	0		29	10	S5884_109_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	110	0		29	10	S5884_110_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	110	0		29	10	S5884_110_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	110	0		29	10	S5884_110_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				37	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	110	0		29	10	S5884_110_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				57	40		40																								40		40				40		30			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	110	0		29	10	S5884_110_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	111	0		29	10	S5884_111_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	111	0		29	10	S5884_111_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	111	0		29	10	S5884_111_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				32	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	111	0		29	10	S5884_111_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				57	37		37																								37		37				37		30			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	111	0		29	10	S5884_111_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	112	0		29	10	S5884_112_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	112	0		29	10	S5884_112_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	112	0		29	10	S5884_112_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	112	0		29	10	S5884_112_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				60	36		36																								36		36				36		30			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	112	0		29	10	S5884_112_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	113	0		29	10	S5884_113_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	113	0		29	10	S5884_113_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	113	0		29	10	S5884_113_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				31	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	113	0		29	10	S5884_113_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				58	41		41																								41		41				41		30			41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	113	0		29	10	S5884_113_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	114	0		29	10	S5884_114_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	114	0		29	10	S5884_114_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	114	0		29	10	S5884_114_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				40	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	114	0		29	10	S5884_114_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				66	35		35																								35		35				35		30			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	114	0		29	10	S5884_114_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					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	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	115	0		29	10	S5884_115_0	2	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	115	0		29	10	S5884_115_0	2	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				33	25		25																								25		25				25		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	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				59	44		44																								44		44				44		30			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	115	0		29	10	S5884_115_0	2	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	116	0		29	10	S5884_116_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	116	0		29	10	S5884_116_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	116	0		29	10	S5884_116_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				38	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	116	0		29	10	S5884_116_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				56	35		35																								35		35				35		30			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	116	0		29	10	S5884_116_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	131	0		29	10	S5884_131_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	131	0		29	10	S5884_131_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	131	0		29	10	S5884_131_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	131	0		29	10	S5884_131_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				60	35		35																								35		35				35		30			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	131	0		29	10	S5884_131_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	132	0		29	10	S5884_132_0	2	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	132	0		29	10	S5884_132_0	2	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	132	0		29	10	S5884_132_0	2	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				33	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	132	0		29	10	S5884_132_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				63	38		38																								38		38				38		30			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	132	0		29	10	S5884_132_0	2	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	133	0		29	10	S5884_133_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	133	0		29	10	S5884_133_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	133	0		29	10	S5884_133_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				35	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	133	0		29	10	S5884_133_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				66	37		37																								37		37				37		30			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	133	0		29	10	S5884_133_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	134	0		29	10	S5884_134_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	134	0		29	10	S5884_134_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	134	0		29	10	S5884_134_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				31	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	134	0		29	10	S5884_134_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				65	47		47																								47		47				47		30			47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	134	0		29	10	S5884_134_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	135	0		29	10	S5884_135_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	135	0		29	10	S5884_135_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	135	0		29	10	S5884_135_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				33	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	135	0		29	10	S5884_135_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				56	39		39																								39		39				39		30			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	135	0		29	10	S5884_135_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	136	0		29	10	S5884_136_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	136	0		29	10	S5884_136_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	136	0		29	10	S5884_136_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				30	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	136	0		29	10	S5884_136_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				52	38		38																								38		38				38		30			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	136	0		29	10	S5884_136_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	137	0		29	10	S5884_137_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	137	0		29	10	S5884_137_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	137	0		29	10	S5884_137_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				33	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	137	0		29	10	S5884_137_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				61	39		39																								39		39				39		30			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	137	0		29	10	S5884_137_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	138	0		29	10	S5884_138_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	138	0		29	10	S5884_138_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	138	0		29	10	S5884_138_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				33	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	138	0		29	10	S5884_138_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				58	39		39																								39		39				39		30			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	138	0		29	10	S5884_138_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	139	0		29	10	S5884_139_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	139	0		29	10	S5884_139_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	139	0		29	10	S5884_139_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				32	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	139	0		29	10	S5884_139_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				58	38		38																								38		38				38		30			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	139	0		29	10	S5884_139_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	140	0		29	10	S5884_140_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	140	0		29	10	S5884_140_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	140	0		29	10	S5884_140_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				30	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	140	0		29	10	S5884_140_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				57	39		39																								39		39				39		30			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	140	0		29	10	S5884_140_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	141	0		29	10	S5884_141_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	141	0		29	10	S5884_141_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	141	0		29	10	S5884_141_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				27	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	141	0		29	10	S5884_141_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				54	44		44																								44		44				44		30			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	141	0		29	10	S5884_141_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	142	0		29	10	S5884_142_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	142	0		29	10	S5884_142_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	142	0		29	10	S5884_142_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				35	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	142	0		29	10	S5884_142_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				55	41		41																								41		41				41		30			41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	142	0		29	10	S5884_142_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	143	0		29	10	S5884_143_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	143	0		29	10	S5884_143_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	143	0		29	10	S5884_143_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				37	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	143	0		29	10	S5884_143_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				66	37		37																								37		37				37		30			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	143	0		29	10	S5884_143_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	144	0		29	10	S5884_144_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	144	0		29	10	S5884_144_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	144	0		29	10	S5884_144_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	144	0		29	10	S5884_144_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				58	38		38																								38		38				38		30			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	144	0		29	10	S5884_144_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	145	0		29	10	S5884_145_0	2	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	145	0		29	10	S5884_145_0	2	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	145	0		29	10	S5884_145_0	2	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				30	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	145	0		29	10	S5884_145_0	2	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				55	38		38																								38		38				38		30			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	145	0		29	10	S5884_145_0	2	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	146	0		29	10	S5884_146_0	2	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	146	0		29	10	S5884_146_0	2	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	146	0		29	10	S5884_146_0	2	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				34	25		25																								25		25				25		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	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				62	42		42																								42		42				42		30			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	146	0		29	10	S5884_146_0	2	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					25																										25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	147	0		29	10	S5884_147_0	1	Preferred Generic	2	11	1	2	1	1	110		1		110	1	30		90				1	2				30		90	30		31	0		0																									0		0				0		0				0				0		0				0	0	0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	147	0		29	10	S5884_147_0	1	Generic	2	11	1	2	2	1	110		1		110	1	30		90				2	2				30		90	30		31	1		3																									1		3				1		0				1				1		0.03				0.03	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	147	0		29	10	S5884_147_0	1	Preferred Brand	2	11	1	1	3	1	110		1		110	1	30		90				2	2				30		90	30		31				30	25		25																								25		25				25		15			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	147	0		29	10	S5884_147_0	1	Non-Preferred Drug	2	11	1	1	4	1	110		1		110	1	30		90				2	2				30		90	30		31				60	39		39																								39		39				39		30			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	147	0		29	10	S5884_147_0	1	Specialty Tier	2	11	1	1	5	1	10		1		10	1	30											30			30		31					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	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	148	0		29	10	S5884_148_0	2	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	148	0		29	10	S5884_148_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	148	0		29	10	S5884_148_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											76	50		50				59	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	148	0		29	10	S5884_148_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	149	0		29	10	S5884_149_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	149	0		29	10	S5884_149_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	149	0		29	10	S5884_149_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											85	50		50				70	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	149	0		29	10	S5884_149_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	150	0		29	10	S5884_150_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	150	0		29	10	S5884_150_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	150	0		29	10	S5884_150_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											83	50		50				68	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	150	0		29	10	S5884_150_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	151	0		29	10	S5884_151_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	151	0		29	10	S5884_151_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	151	0		29	10	S5884_151_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											83	50		50				68	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	151	0		29	10	S5884_151_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	152	0		29	10	S5884_152_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	152	0		29	10	S5884_152_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	152	0		29	10	S5884_152_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											69	50		50				68	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	152	0		29	10	S5884_152_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	153	0		29	10	S5884_153_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	153	0		29	10	S5884_153_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	153	0		29	10	S5884_153_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											69	50		50				57	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	153	0		29	10	S5884_153_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	154	0		29	10	S5884_154_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	154	0		29	10	S5884_154_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	154	0		29	10	S5884_154_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											80	50		50				54	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	154	0		29	10	S5884_154_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	155	0		29	10	S5884_155_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	155	0		29	10	S5884_155_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	155	0		29	10	S5884_155_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											73	50		50				58	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	155	0		29	10	S5884_155_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	156	0		29	10	S5884_156_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	156	0		29	10	S5884_156_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	156	0		29	10	S5884_156_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											78	50		50				67	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	156	0		29	10	S5884_156_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	157	0		29	10	S5884_157_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	157	0		29	10	S5884_157_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	157	0		29	10	S5884_157_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											79	50		50				72	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	157	0		29	10	S5884_157_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	158	0		29	10	S5884_158_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	158	0		29	10	S5884_158_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	158	0		29	10	S5884_158_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											80	50		50				70	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	158	0		29	10	S5884_158_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	159	0		29	10	S5884_159_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	159	0		29	10	S5884_159_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	159	0		29	10	S5884_159_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											73	50		50				63	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	159	0		29	10	S5884_159_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	160	0		29	10	S5884_160_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	160	0		29	10	S5884_160_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	160	0		29	10	S5884_160_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											80	50		50				54	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	160	0		29	10	S5884_160_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	161	0		29	10	S5884_161_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	161	0		29	10	S5884_161_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	161	0		29	10	S5884_161_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											72	50		50				62	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	161	0		29	10	S5884_161_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	162	0		29	10	S5884_162_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	162	0		29	10	S5884_162_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	162	0		29	10	S5884_162_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											86	50		50				56	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	162	0		29	10	S5884_162_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	163	0		29	10	S5884_163_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	163	0		29	10	S5884_163_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	163	0		29	10	S5884_163_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											79	50		50				77	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	163	0		29	10	S5884_163_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	164	0		29	10	S5884_164_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	164	0		29	10	S5884_164_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	164	0		29	10	S5884_164_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											76	50		50				64	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	164	0		29	10	S5884_164_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	165	0		29	10	S5884_165_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	165	0		29	10	S5884_165_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	165	0		29	10	S5884_165_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											73	50		50				63	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	165	0		29	10	S5884_165_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	166	0		29	10	S5884_166_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	166	0		29	10	S5884_166_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	166	0		29	10	S5884_166_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											75	50		50				57	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	166	0		29	10	S5884_166_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	167	0		29	10	S5884_167_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	167	0		29	10	S5884_167_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	167	0		29	10	S5884_167_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											84	50		50				56	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	167	0		29	10	S5884_167_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	168	0		29	10	S5884_168_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	168	0		29	10	S5884_168_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	168	0		29	10	S5884_168_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											81	50		50				68	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	168	0		29	10	S5884_168_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	169	0		29	10	S5884_169_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	169	0		29	10	S5884_169_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	169	0		29	10	S5884_169_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											81	50		50				71	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	169	0		29	10	S5884_169_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	170	0		29	10	S5884_170_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	170	0		29	10	S5884_170_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	170	0		29	10	S5884_170_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											73	50		50				58	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	170	0		29	10	S5884_170_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	171	0		29	10	S5884_171_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	171	0		29	10	S5884_171_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	171	0		29	10	S5884_171_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											75	50		50				54	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	171	0		29	10	S5884_171_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	172	0		29	10	S5884_172_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	172	0		29	10	S5884_172_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	172	0		29	10	S5884_172_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											86	50		50				62	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	172	0		29	10	S5884_172_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	173	0		29	10	S5884_173_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	173	0		29	10	S5884_173_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	173	0		29	10	S5884_173_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											89	50		50				72	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	173	0		29	10	S5884_173_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	174	0		29	10	S5884_174_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	174	0		29	10	S5884_174_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	174	0		29	10	S5884_174_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											85	50		50				66	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	174	0		29	10	S5884_174_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	175	0		29	10	S5884_175_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	175	0		29	10	S5884_175_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	175	0		29	10	S5884_175_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											82	50		50				69	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	175	0		29	10	S5884_175_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	176	0		29	10	S5884_176_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	176	0		29	10	S5884_176_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	176	0		29	10	S5884_176_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											73	50		50				57	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	176	0		29	10	S5884_176_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	177	0		29	10	S5884_177_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	177	0		29	10	S5884_177_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	177	0		29	10	S5884_177_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											73	50		50				60	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	177	0		29	10	S5884_177_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	178	0		29	10	S5884_178_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	178	0		29	10	S5884_178_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	178	0		29	10	S5884_178_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											83	50		50				66	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	178	0		29	10	S5884_178_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	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	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	179	0		29	10	S5884_179_0	2	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	179	0		29	10	S5884_179_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	179	0		29	10	S5884_179_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											100	50		50				76	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	179	0		29	10	S5884_179_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	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	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								5		15					1		3											5		15				1		0				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	180	0		29	10	S5884_180_0	1	Generic	4	11	3	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								10		30					4		12											10		30				4		0				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	180	0		29	10	S5884_180_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					42		126											47		141				42		116				47				47			1.57	1.4		1.57	1.4	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	180	0		29	10	S5884_180_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											78	50		50				76	44		44										50		50				44		44			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	180	0		29	10	S5884_180_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	181	0		29	10	S5884_181_0	2	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	181	0		29	10	S5884_181_0	2	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	181	0		29	10	S5884_181_0	2	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	181	0		29	10	S5884_181_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				62	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	181	0		29	10	S5884_181_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	182	0		29	10	S5884_182_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	182	0		29	10	S5884_182_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	182	0		29	10	S5884_182_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	182	0		29	10	S5884_182_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				64	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	182	0		29	10	S5884_182_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	183	0		29	10	S5884_183_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	183	0		29	10	S5884_183_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	183	0		29	10	S5884_183_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	183	0		29	10	S5884_183_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											100	50		50				63	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	183	0		29	10	S5884_183_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	184	0		29	10	S5884_184_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	184	0		29	10	S5884_184_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	184	0		29	10	S5884_184_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	184	0		29	10	S5884_184_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				63	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	184	0		29	10	S5884_184_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	185	0		29	10	S5884_185_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	185	0		29	10	S5884_185_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	185	0		29	10	S5884_185_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	185	0		29	10	S5884_185_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											95	50		50				61	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	185	0		29	10	S5884_185_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	186	0		29	10	S5884_186_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	186	0		29	10	S5884_186_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	186	0		29	10	S5884_186_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	186	0		29	10	S5884_186_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				59	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	186	0		29	10	S5884_186_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	187	0		29	10	S5884_187_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	187	0		29	10	S5884_187_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	187	0		29	10	S5884_187_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	187	0		29	10	S5884_187_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											89	50		50				58	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	187	0		29	10	S5884_187_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	188	0		29	10	S5884_188_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	188	0		29	10	S5884_188_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	188	0		29	10	S5884_188_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	188	0		29	10	S5884_188_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											93	50		50				59	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	188	0		29	10	S5884_188_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	189	0		29	10	S5884_189_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	189	0		29	10	S5884_189_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	189	0		29	10	S5884_189_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	189	0		29	10	S5884_189_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											91	50		50				58	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	189	0		29	10	S5884_189_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	190	0		29	10	S5884_190_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	190	0		29	10	S5884_190_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	190	0		29	10	S5884_190_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	190	0		29	10	S5884_190_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											93	50		50				60	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	190	0		29	10	S5884_190_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	191	0		29	10	S5884_191_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	191	0		29	10	S5884_191_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	191	0		29	10	S5884_191_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	191	0		29	10	S5884_191_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											88	50		50				57	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	191	0		29	10	S5884_191_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	192	0		29	10	S5884_192_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	192	0		29	10	S5884_192_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	192	0		29	10	S5884_192_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	192	0		29	10	S5884_192_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											93	50		50				62	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	192	0		29	10	S5884_192_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	193	0		29	10	S5884_193_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	193	0		29	10	S5884_193_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	193	0		29	10	S5884_193_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	193	0		29	10	S5884_193_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				58	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	193	0		29	10	S5884_193_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	194	0		29	10	S5884_194_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	194	0		29	10	S5884_194_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	194	0		29	10	S5884_194_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	194	0		29	10	S5884_194_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											88	50		50				55	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	194	0		29	10	S5884_194_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	195	0		29	10	S5884_195_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	195	0		29	10	S5884_195_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	195	0		29	10	S5884_195_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	195	0		29	10	S5884_195_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											92	50		50				57	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	195	0		29	10	S5884_195_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	196	0		29	10	S5884_196_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	196	0		29	10	S5884_196_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	196	0		29	10	S5884_196_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	196	0		29	10	S5884_196_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											92	50		50				58	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	196	0		29	10	S5884_196_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	197	0		29	10	S5884_197_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	197	0		29	10	S5884_197_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	197	0		29	10	S5884_197_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	197	0		29	10	S5884_197_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											89	50		50				56	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	197	0		29	10	S5884_197_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	198	0		29	10	S5884_198_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	198	0		29	10	S5884_198_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	198	0		29	10	S5884_198_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	198	0		29	10	S5884_198_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											86	50		50				56	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	198	0		29	10	S5884_198_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	199	0		29	10	S5884_199_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	199	0		29	10	S5884_199_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	199	0		29	10	S5884_199_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	199	0		29	10	S5884_199_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											85	50		50				57	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	199	0		29	10	S5884_199_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	200	0		29	10	S5884_200_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	200	0		29	10	S5884_200_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	200	0		29	10	S5884_200_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	200	0		29	10	S5884_200_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											87	50		50				57	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	200	0		29	10	S5884_200_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	201	0		29	10	S5884_201_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	201	0		29	10	S5884_201_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	201	0		29	10	S5884_201_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	201	0		29	10	S5884_201_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											93	50		50				60	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	201	0		29	10	S5884_201_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	202	0		29	10	S5884_202_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	202	0		29	10	S5884_202_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	202	0		29	10	S5884_202_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	202	0		29	10	S5884_202_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											89	50		50				57	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	202	0		29	10	S5884_202_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	203	0		29	10	S5884_203_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	203	0		29	10	S5884_203_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	203	0		29	10	S5884_203_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	203	0		29	10	S5884_203_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											88	50		50				55	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	203	0		29	10	S5884_203_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	204	0		29	10	S5884_204_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	204	0		29	10	S5884_204_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	204	0		29	10	S5884_204_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	204	0		29	10	S5884_204_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											91	50		50				57	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	204	0		29	10	S5884_204_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	205	0		29	10	S5884_205_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	205	0		29	10	S5884_205_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	205	0		29	10	S5884_205_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	205	0		29	10	S5884_205_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				65	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	205	0		29	10	S5884_205_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	206	0		29	10	S5884_206_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	206	0		29	10	S5884_206_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	206	0		29	10	S5884_206_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	206	0		29	10	S5884_206_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											95	50		50				61	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	206	0		29	10	S5884_206_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	207	0		29	10	S5884_207_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	207	0		29	10	S5884_207_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	207	0		29	10	S5884_207_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	207	0		29	10	S5884_207_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											96	50		50				59	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	207	0		29	10	S5884_207_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	208	0		29	10	S5884_208_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	208	0		29	10	S5884_208_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	208	0		29	10	S5884_208_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	208	0		29	10	S5884_208_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											90	50		50				58	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	208	0		29	10	S5884_208_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	209	0		29	10	S5884_209_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	209	0		29	10	S5884_209_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	209	0		29	10	S5884_209_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	209	0		29	10	S5884_209_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											95	50		50				62	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	209	0		29	10	S5884_209_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	210	0		29	10	S5884_210_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	210	0		29	10	S5884_210_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	210	0		29	10	S5884_210_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	210	0		29	10	S5884_210_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											91	50		50				57	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	210	0		29	10	S5884_210_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	211	0		29	10	S5884_211_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	211	0		29	10	S5884_211_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	211	0		29	10	S5884_211_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	211	0		29	10	S5884_211_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				62	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	211	0		29	10	S5884_211_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	212	0		29	10	S5884_212_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	212	0		29	10	S5884_212_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	212	0		29	10	S5884_212_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	212	0		29	10	S5884_212_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											94	50		50				65	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	212	0		29	10	S5884_212_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	213	0		29	10	S5884_213_0	1	Preferred Generic	4	11	1	2	1	1		110	1		110	1				30		90	1	2				30		90	30		31								10		30					1		3											10		30				1		3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	213	0		29	10	S5884_213_0	1	Generic	4	11	1	2	2	1		110	1		110	1				30		90	2	2				30		90	30		31								20		60					4		12											20		60				4		12				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	213	0		29	10	S5884_213_0	1	Preferred Brand	4	11	1	2	3	1		110	1		110	1				30		90	2	2				30		90	30		31								47		141					47		141											47		141				47		141				47				47			1.57	1.57		1.57	1.57	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	213	0		29	10	S5884_213_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		110	1				30		90	2	2				30		90	30		31											88	50		50				61	35		35										50		50				35		35			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5884	213	0		29	10	S5884_213_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5904	1	0		29	10	S5904_001_0	9	Preferred Generic	3	1	1	2	1	1	110		1	110		1	31		90				1	2	31		90				31		31	0		0																			0		0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5904	1	0		29	10	S5904_001_0	9	Generic	3	1	1	2	2	1	110		1	110		1	31		90				1	2	31		90				31		31	9		27																			9		27																9				9		0.29			0.29			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5904	1	0		29	10	S5904_001_0	9	Preferred Brand	3	11	1	2	3	1	110		1	110		1	31		90				1	2	31		90				31		31	47		141																			47		141																47				47		1.52			1.52			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5904	1	0		29	10	S5904_001_0	9	Non-Preferred Drug	3	11	1	1	4	1	110		1	110		1	31		90				1	2	31		90				31		31				73.81	50		50																		50		50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5904	1	0		29	10	S5904_001_0	9	Specialty Tier	3	11	1	1	5	1	10		1	10		1	31								31						31		31				945.9	26																				26																	26			26								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5904	2	0		29	10	S5904_002_0	4	Preferred Generic	4	1	1	2	1	1		110	1	110		1				31		90	1	1	31		90				31		31								13		39					3		9					3		9																13				3			0.42	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5904	2	0		29	10	S5904_002_0	4	Preferred Generic	4	1	1	2	1	3		110	1	110		1				31		90	1	1	31		90				31		31								13		39					3		9					3		9																13				3			0.42	0.1	0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5904	2	0		29	10	S5904_002_0	4	Generic	4	1	1	2	2	1		110	1	110		1				31		90	1	1	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5904	2	0		29	10	S5904_002_0	4	Generic	4	1	1	2	2	3		110	1	110		1				31		90	1	1	31		90				31		31								20		60					10		30					10		30																20				10			0.65	0.32	0.32			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"										1		
S5904	2	0		29	10	S5904_002_0	4	Preferred Brand	4	11	1	2	3	1		110	1	110		1				31		90	1	1	31		90				31		31								47		141					40		120					40		120																47				40			1.52	1.29	1.29			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5904	2	0		29	10	S5904_002_0	4	Non-Preferred Brand	4	11	1	2	4	1		110	1	110		1				31		90	1	1	31		90				31		31								100		300					93		279					93		279																100				93			3.23	3	3			3	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5904	2	0		29	10	S5904_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				31					31						31		31											892.86	33						892.86	33						33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier"												
S5916	1	0		29	10	S5916_001_0	5	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	1	0		29	10	S5916_001_0	5	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	34					10	20	20					10	20	20																17				17			0.57	0.33	0.33			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	1	0		29	10	S5916_001_0	5	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	1	0		29	10	S5916_001_0	5	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											62.6	35	35	35				53.66	30	30	30				30	30	30															35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	1	0		29	10	S5916_001_0	5	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	2	0		29	10	S5916_002_0	8	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	6																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	2	0		29	10	S5916_002_0	8	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	3	6	6																			3	6	6																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5916	2	0		29	10	S5916_002_0	8	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	10	20	20																			10	20	20																10				10		0.33			0.33			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	2	0		29	10	S5916_002_0	8	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	117.5																			47	94	117.5																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	2	0		29	10	S5916_002_0	8	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				71.54	40	40	40																		40	40	40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	2	0		29	10	S5916_002_0	8	Specialty Tier	4	11	1	1	5	1	10		1	10		1	30								30						30		31				853.32	33																				33																	33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	3	0		29	10	S5916_003_0	8	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								10	20	20					3	6	6					3	6	6																10				10			0.33	0.1	0.1			0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	3	0		29	10	S5916_003_0	8	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								17	34	34					10	20	20					10	20	20																17				17			0.57	0.33	0.33			0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	3	0		29	10	S5916_003_0	8	Preferred Brand	4	11	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	117.5					40	80	100					40	80	100																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	3	0		29	10	S5916_003_0	8	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											62.6	35	35	35				53.66	30	30	30				30	30	30															35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5916	3	0		29	10	S5916_003_0	8	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											724.03	28						724.03	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	348	0		29	10	S5921_348_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	348	0		29	10	S5921_348_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	348	0		29	10	S5921_348_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	348	0		29	10	S5921_348_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											65	35		35				61	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	348	0		29	10	S5921_348_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											529	25		25				504	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	349	0		29	10	S5921_349_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	349	0		29	10	S5921_349_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	349	0		29	10	S5921_349_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								29		87					25		75													87						75				29				29			0.96	0.83				0.93	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	349	0		29	10	S5921_349_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											72	35		35				60	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	349	0		29	10	S5921_349_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											527	25		25				515	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	350	0		29	10	S5921_350_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	350	0		29	10	S5921_350_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								12		36					7		21													36						21				12				12			0.4	0.23				0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	350	0		29	10	S5921_350_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								32		96					27		81													96						81				32				32			1.06	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	350	0		29	10	S5921_350_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											69	35		35				52	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	350	0		29	10	S5921_350_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											521	25		25				516	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	351	0		29	10	S5921_351_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	351	0		29	10	S5921_351_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	351	0		29	10	S5921_351_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								31		93					26		78													93						78				31				31			1.03	0.86				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	351	0		29	10	S5921_351_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											63	35		35				53	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	351	0		29	10	S5921_351_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											532	25		25				504	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	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	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	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								12		36					7		21													36						21				12				12			0.4	0.23				0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	352	0		29	10	S5921_352_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								32		96					27		81													96						81				32				32			1.06	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	352	0		29	10	S5921_352_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											70	35		35				64	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	352	0		29	10	S5921_352_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											562	25		25				520	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	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	353	0		29	10	S5921_353_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	353	0		29	10	S5921_353_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								32		96					27		81													96						81				32				32			1.06	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	353	0		29	10	S5921_353_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											72	35		35				62	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	353	0		29	10	S5921_353_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											517	25		25				553	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	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	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	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	354	0		29	10	S5921_354_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								36		108					31		93													108						93				36				36			1.2	1.03				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	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											70	35		35				58	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	354	0		29	10	S5921_354_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											695	25		25				672	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	355	0		29	10	S5921_355_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	355	0		29	10	S5921_355_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	355	0		29	10	S5921_355_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								32		96					27		81													96						81				32				32			1.06	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	355	0		29	10	S5921_355_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											66	35		35				58	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	355	0		29	10	S5921_355_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											700	25		25				644	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	356	0		29	10	S5921_356_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	356	0		29	10	S5921_356_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	356	0		29	10	S5921_356_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								34		102					29		87													102						87				34				34			1.13	0.96				1.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	356	0		29	10	S5921_356_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											76	35		35				59	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	356	0		29	10	S5921_356_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											707	25		25				710	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	357	0		29	10	S5921_357_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	357	0		29	10	S5921_357_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	357	0		29	10	S5921_357_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								31		93					26		78													93						78				31				31			1.03	0.86				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	357	0		29	10	S5921_357_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											68	35		35				65	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	357	0		29	10	S5921_357_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											550	25		25				541	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	358	0		29	10	S5921_358_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	358	0		29	10	S5921_358_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	358	0		29	10	S5921_358_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								31		93					26		78													93						78				31				31			1.03	0.86				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	358	0		29	10	S5921_358_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											68	35		35				51	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	358	0		29	10	S5921_358_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											500	25		25				466	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	359	0		29	10	S5921_359_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	359	0		29	10	S5921_359_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								12		36					7		21													36						21				12				12			0.4	0.23				0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	359	0		29	10	S5921_359_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								34		102					29		87													102						87				34				34			1.13	0.96				1.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	359	0		29	10	S5921_359_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											61	35		35				63	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	359	0		29	10	S5921_359_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											509	25		25				481	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	360	0		29	10	S5921_360_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	360	0		29	10	S5921_360_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	360	0		29	10	S5921_360_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								34		102					29		87													102						87				34				34			1.13	0.96				1.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	360	0		29	10	S5921_360_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											67	35		35				75	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	360	0		29	10	S5921_360_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											516	25		25				507	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	361	0		29	10	S5921_361_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	361	0		29	10	S5921_361_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								12		36					7		21													36						21				12				12			0.4	0.23				0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	361	0		29	10	S5921_361_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	361	0		29	10	S5921_361_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											59	35		35				62	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	361	0		29	10	S5921_361_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											523	25		25				523	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	362	0		29	10	S5921_362_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	362	0		29	10	S5921_362_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	362	0		29	10	S5921_362_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								34		102					29		87													102						87				34				34			1.13	0.96				1.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	362	0		29	10	S5921_362_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											59	35		35				65	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	362	0		29	10	S5921_362_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											556	25		25				540	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	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	363	0		29	10	S5921_363_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	363	0		29	10	S5921_363_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								33		99					28		84													99						84				33				33			1.1	0.93				1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	363	0		29	10	S5921_363_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											63	35		35				56	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	363	0		29	10	S5921_363_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											583	25		25				514	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	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	364	0		29	10	S5921_364_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	364	0		29	10	S5921_364_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	364	0		29	10	S5921_364_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											69	35		35				55	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	364	0		29	10	S5921_364_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											785	25		25				688	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	365	0		29	10	S5921_365_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	365	0		29	10	S5921_365_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								12		36					7		21													36						21				12				12			0.4	0.23				0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	365	0		29	10	S5921_365_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								31		93					26		78													93						78				31				31			1.03	0.86				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	365	0		29	10	S5921_365_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											75	35		35				55	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	365	0		29	10	S5921_365_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											701	25		25				609	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	366	0		29	10	S5921_366_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	366	0		29	10	S5921_366_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	366	0		29	10	S5921_366_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								29		87					25		75													87						75				29				29			0.96	0.83				0.93	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	366	0		29	10	S5921_366_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											80	35		35				60	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	366	0		29	10	S5921_366_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											589	25		25				588	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	367	0		29	10	S5921_367_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	367	0		29	10	S5921_367_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	367	0		29	10	S5921_367_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								32		96					27		81													96						81				32				32			1.06	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	367	0		29	10	S5921_367_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											76	35		35				59	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	367	0		29	10	S5921_367_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											672	25		25				644	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	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	368	0		29	10	S5921_368_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	368	0		29	10	S5921_368_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								31		93					26		78													93						78				31				31			1.03	0.86				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	368	0		29	10	S5921_368_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											69	35		35				60	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	368	0		29	10	S5921_368_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											544	25		25				566	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	369	0		29	10	S5921_369_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	369	0		29	10	S5921_369_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								12		36					7		21													36						21				12				12			0.4	0.23				0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	369	0		29	10	S5921_369_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	369	0		29	10	S5921_369_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											64	35		35				59	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	369	0		29	10	S5921_369_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											615	25		25				547	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	370	0		29	10	S5921_370_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	370	0		29	10	S5921_370_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	370	0		29	10	S5921_370_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								33		99					28		84													99						84				33				33			1.1	0.93				1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	370	0		29	10	S5921_370_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											62	35		35				57	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	370	0		29	10	S5921_370_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											476	25		25				452	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	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	371	0		29	10	S5921_371_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								12		36					7		21													36						21				12				12			0.4	0.23				0.38	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	371	0		29	10	S5921_371_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	371	0		29	10	S5921_371_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											65	35		35				59	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	371	0		29	10	S5921_371_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											702	25		25				591	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	372	0		29	10	S5921_372_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	372	0		29	10	S5921_372_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	372	0		29	10	S5921_372_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								31		93					26		78													93						78				31				31			1.03	0.86				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	372	0		29	10	S5921_372_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											73	35		35				59	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	372	0		29	10	S5921_372_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											511	25		25				511	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	373	0		29	10	S5921_373_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	373	0		29	10	S5921_373_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	373	0		29	10	S5921_373_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								33		99					28		84													99						84				33				33			1.1	0.93				1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	373	0		29	10	S5921_373_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											65	35		35				69	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	373	0		29	10	S5921_373_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											511	25		25				505	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	374	0		29	10	S5921_374_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	374	0		29	10	S5921_374_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	374	0		29	10	S5921_374_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								31		93					26		78													93						78				31				31			1.03	0.86				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	374	0		29	10	S5921_374_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											64	35		35				54	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	374	0		29	10	S5921_374_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											595	25		25				569	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	375	0		29	10	S5921_375_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	375	0		29	10	S5921_375_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	375	0		29	10	S5921_375_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								32		96					27		81													96						81				32				32			1.06	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	375	0		29	10	S5921_375_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											64	35		35				56	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	375	0		29	10	S5921_375_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											574	25		25				470	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	376	0		29	10	S5921_376_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	376	0		29	10	S5921_376_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								10		30					5		15													30						15				10				10			0.33	0.16				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	376	0		29	10	S5921_376_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								27		81					25		75													81						75				27				27			0.9	0.83				0.87	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	376	0		29	10	S5921_376_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											73	35		35				62	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	376	0		29	10	S5921_376_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											542	25		25				519	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	377	0		29	10	S5921_377_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	377	0		29	10	S5921_377_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	377	0		29	10	S5921_377_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	377	0		29	10	S5921_377_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											67	35		35				52	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	377	0		29	10	S5921_377_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											388	25		25				391	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	378	0		29	10	S5921_378_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	378	0		29	10	S5921_378_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								11		33					6		18													33						18				11				11			0.36	0.2				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	378	0		29	10	S5921_378_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								34		102					29		87													102						87				34				34			1.13	0.96				1.09	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	378	0		29	10	S5921_378_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											66	35		35				49	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	378	0		29	10	S5921_378_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											512	25		25				464	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	379	0		29	10	S5921_379_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	379	0		29	10	S5921_379_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	379	0		29	10	S5921_379_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								30		90					25		75													90						75				30				30			1	0.83				0.96	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	379	0		29	10	S5921_379_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											70	35		35				64	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	379	0		29	10	S5921_379_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											728	25		25				642	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	380	0		29	10	S5921_380_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	380	0		29	10	S5921_380_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	380	0		29	10	S5921_380_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								38		114					33		99													114						99				38				38			1.26	1.1				1.22	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	380	0		29	10	S5921_380_0	2	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											79	35		35				59	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	380	0		29	10	S5921_380_0	2	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											546	25		25				542	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	381	0		29	10	S5921_381_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								6		18					1		3													18						3				6				6			0.2	0.03				0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	381	0		29	10	S5921_381_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								13		39					8		24													39						24				13				13			0.43	0.26				0.41	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	381	0		29	10	S5921_381_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								32		96					27		81													96						81				32				32			1.06	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	381	0		29	10	S5921_381_0	1	Non-Preferred Drug	2	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											73	35		35				57	35		35												35						35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	381	0		29	10	S5921_381_0	1	Specialty Tier	2	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											539	25		25				807	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	382	0		29	10	S5921_382_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	382	0		29	10	S5921_382_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	382	0		29	10	S5921_382_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	382	0		29	10	S5921_382_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											69	33		33				58	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	382	0		29	10	S5921_382_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1034	25		25				882	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	383	0		29	10	S5921_383_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	383	0		29	10	S5921_383_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	383	0		29	10	S5921_383_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	383	0		29	10	S5921_383_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											75	33		33				61	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	383	0		29	10	S5921_383_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1075	25		25				884	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	384	0		29	10	S5921_384_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	384	0		29	10	S5921_384_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	384	0		29	10	S5921_384_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	384	0		29	10	S5921_384_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											59	33		33				44	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	384	0		29	10	S5921_384_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1488	25		25				1108	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	385	0		29	10	S5921_385_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	385	0		29	10	S5921_385_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	385	0		29	10	S5921_385_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	385	0		29	10	S5921_385_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											66	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	385	0		29	10	S5921_385_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1212	25		25				1000	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	386	0		29	10	S5921_386_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	386	0		29	10	S5921_386_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	386	0		29	10	S5921_386_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	386	0		29	10	S5921_386_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											65	33		33				61	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	386	0		29	10	S5921_386_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1099	25		25				836	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	387	0		29	10	S5921_387_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	387	0		29	10	S5921_387_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	387	0		29	10	S5921_387_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	387	0		29	10	S5921_387_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											73	33		33				55	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	387	0		29	10	S5921_387_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1017	25		25				865	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	388	0		29	10	S5921_388_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	388	0		29	10	S5921_388_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	388	0		29	10	S5921_388_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	388	0		29	10	S5921_388_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											73	33		33				53	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	388	0		29	10	S5921_388_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1330	25		25				1092	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	389	0		29	10	S5921_389_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	389	0		29	10	S5921_389_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	389	0		29	10	S5921_389_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	389	0		29	10	S5921_389_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											72	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	389	0		29	10	S5921_389_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1047	25		25				812	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	390	0		29	10	S5921_390_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	390	0		29	10	S5921_390_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	390	0		29	10	S5921_390_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	390	0		29	10	S5921_390_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											77	33		33				49	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	390	0		29	10	S5921_390_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											985	25		25				906	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	391	0		29	10	S5921_391_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	391	0		29	10	S5921_391_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	391	0		29	10	S5921_391_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	391	0		29	10	S5921_391_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											75	33		33				55	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	391	0		29	10	S5921_391_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1162	25		25				960	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	392	0		29	10	S5921_392_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	392	0		29	10	S5921_392_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	392	0		29	10	S5921_392_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	392	0		29	10	S5921_392_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											75	33		33				55	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	392	0		29	10	S5921_392_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1176	25		25				1096	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	393	0		29	10	S5921_393_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	393	0		29	10	S5921_393_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	393	0		29	10	S5921_393_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	393	0		29	10	S5921_393_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											78	33		33				49	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	393	0		29	10	S5921_393_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1172	25		25				1049	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	394	0		29	10	S5921_394_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	394	0		29	10	S5921_394_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	394	0		29	10	S5921_394_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	394	0		29	10	S5921_394_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											54	33		33				53	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	394	0		29	10	S5921_394_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1287	25		25				975	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	395	0		29	10	S5921_395_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	395	0		29	10	S5921_395_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	395	0		29	10	S5921_395_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	395	0		29	10	S5921_395_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											67	33		33				54	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	395	0		29	10	S5921_395_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1219	25		25				975	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	396	0		29	10	S5921_396_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	396	0		29	10	S5921_396_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	396	0		29	10	S5921_396_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	396	0		29	10	S5921_396_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											67	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	396	0		29	10	S5921_396_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1260	25		25				1036	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	397	0		29	10	S5921_397_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	397	0		29	10	S5921_397_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	397	0		29	10	S5921_397_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	397	0		29	10	S5921_397_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											79	33		33				50	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	397	0		29	10	S5921_397_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1293	25		25				1212	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	398	0		29	10	S5921_398_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	398	0		29	10	S5921_398_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	398	0		29	10	S5921_398_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	398	0		29	10	S5921_398_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											77	33		33				55	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	398	0		29	10	S5921_398_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1206	25		25				1032	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	399	0		29	10	S5921_399_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	399	0		29	10	S5921_399_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	399	0		29	10	S5921_399_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	399	0		29	10	S5921_399_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											57	33		33				46	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	399	0		29	10	S5921_399_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1223	25		25				1175	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	400	0		29	10	S5921_400_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	400	0		29	10	S5921_400_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	400	0		29	10	S5921_400_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	400	0		29	10	S5921_400_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											72	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	400	0		29	10	S5921_400_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											946	25		25				903	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	401	0		29	10	S5921_401_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	401	0		29	10	S5921_401_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	401	0		29	10	S5921_401_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	401	0		29	10	S5921_401_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											69	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	401	0		29	10	S5921_401_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1547	25		25				935	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	402	0		29	10	S5921_402_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	402	0		29	10	S5921_402_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	402	0		29	10	S5921_402_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	402	0		29	10	S5921_402_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											61	33		33				58	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	402	0		29	10	S5921_402_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1127	25		25				883	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	403	0		29	10	S5921_403_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	403	0		29	10	S5921_403_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	403	0		29	10	S5921_403_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	403	0		29	10	S5921_403_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											69	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	403	0		29	10	S5921_403_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1075	25		25				961	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	404	0		29	10	S5921_404_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	404	0		29	10	S5921_404_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	404	0		29	10	S5921_404_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	404	0		29	10	S5921_404_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											93	33		33				54	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	404	0		29	10	S5921_404_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1407	25		25				1128	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	405	0		29	10	S5921_405_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	405	0		29	10	S5921_405_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	405	0		29	10	S5921_405_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	405	0		29	10	S5921_405_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											57	33		33				52	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	405	0		29	10	S5921_405_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1026	25		25				855	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	406	0		29	10	S5921_406_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	406	0		29	10	S5921_406_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	406	0		29	10	S5921_406_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	406	0		29	10	S5921_406_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											63	33		33				51	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	406	0		29	10	S5921_406_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1162	25		25				859	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	407	0		29	10	S5921_407_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	407	0		29	10	S5921_407_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	407	0		29	10	S5921_407_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	407	0		29	10	S5921_407_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											96	33		33				60	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	407	0		29	10	S5921_407_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1644	25		25				1280	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	408	0		29	10	S5921_408_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	408	0		29	10	S5921_408_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	408	0		29	10	S5921_408_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	408	0		29	10	S5921_408_0	2	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											56	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	408	0		29	10	S5921_408_0	2	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1154	25		25				931	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	409	0		29	10	S5921_409_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	409	0		29	10	S5921_409_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	409	0		29	10	S5921_409_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	409	0		29	10	S5921_409_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											63	33		33				51	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	409	0		29	10	S5921_409_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											965	25		25				838	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	410	0		29	10	S5921_410_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	410	0		29	10	S5921_410_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	410	0		29	10	S5921_410_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	410	0		29	10	S5921_410_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											68	33		33				57	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	410	0		29	10	S5921_410_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1231	25		25				1018	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	411	0		29	10	S5921_411_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	411	0		29	10	S5921_411_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	411	0		29	10	S5921_411_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	411	0		29	10	S5921_411_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											66	33		33				58	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	411	0		29	10	S5921_411_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1428	25		25				1198	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	412	0		29	10	S5921_412_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	412	0		29	10	S5921_412_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	412	0		29	10	S5921_412_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	412	0		29	10	S5921_412_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											56	33		33				45	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	412	0		29	10	S5921_412_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1284	25		25				1102	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	413	0		29	10	S5921_413_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	413	0		29	10	S5921_413_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	413	0		29	10	S5921_413_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	413	0		29	10	S5921_413_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											67	33		33				54	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	413	0		29	10	S5921_413_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											872	25		25				769	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	414	0		29	10	S5921_414_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	414	0		29	10	S5921_414_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	414	0		29	10	S5921_414_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	414	0		29	10	S5921_414_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											86	33		33				56	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	414	0		29	10	S5921_414_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											791	25		25				915	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	415	0		29	10	S5921_415_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	2	2						90	30		31								15		45					0		0													45						0				15				15			0.5	0				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	415	0		29	10	S5921_415_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	2	2						90	30		31								20		60					5		15													60						15				20				20			0.66	0.16				0.64	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	415	0		29	10	S5921_415_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	2	2						90	30		31								47		141					40		120													141						120				47				47			1.56	1.33				1.51	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	415	0		29	10	S5921_415_0	1	Non-Preferred Drug	4	11	1	1	4	1		110	1		100	1				30		90	2	2						90	30		31											81	33		33				49	32		32												33						32			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5921	415	0		29	10	S5921_415_0	1	Specialty Tier	4	11	1	1	5	1		110	1		100	1				30		90	2	2						90	30		31											1214	25		25				904	25		25												25						25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	1	0		29	10	S5953_001_0	3	Preferred Generic	3	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			5	10	12.5																5				5		0.17			0.17			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	1	0		29	10	S5953_001_0	3	Generic	3	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	20	40	60																			20	40	50																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	1	0		29	10	S5953_001_0	3	Preferred Brand	3	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	47	94	141																			47	94	117.5																47				47		1.57			1.57			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	1	0		29	10	S5953_001_0	3	Non-Preferred Drug	3	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				45.71	50	50	50																		50	50	50															50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	1	0		29	10	S5953_001_0	3	Specialty Tier	3	11	1	1	5	1	111		1	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 Drug, Specialty Tier"												
S5953	2	0		29	10	S5953_002_0	3	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	2	0		29	10	S5953_002_0	3	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5953	2	0		29	10	S5953_002_0	3	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	6	7.5																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	2	0		29	10	S5953_002_0	3	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				2	2	30	60	90				30		31	3	6	9																			3	6	7.5																3				3		0.1			0.1			0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5953	2	0		29	10	S5953_002_0	3	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31	20	40	60																			20	40	50																20				20		0.67			0.67			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	2	0		29	10	S5953_002_0	3	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				41.53	40	40	40																		40	40	40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5953	2	0		29	10	S5953_002_0	3	Specialty Tier	4	11	1	1	5	1	111		1	111		1	30	60	90				2	2	30	60	90				30		31				46.75	33	33	33																		33	33	33															33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5960	167	0		29	10	S5960_167_0	3	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								6	12	18					1	2	3					1	2	3																6				6			0.2	0.03	0.03			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5960	167	0		29	10	S5960_167_0	3	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					2	4	6					2	4	6																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5960	167	0		29	10	S5960_167_0	3	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								42	84	126					31	62	93					31	62	93																42				42			1.4	1.03	1.03			1.24	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5960	167	0		29	10	S5960_167_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											99.59	35	35	35				85.37	30	30	30				30	30	30															35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5960	167	0		29	10	S5960_167_0	3	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	3	0		29	10	S5966_003_0	3	Preferred Generic	2	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	3	0		29	10	S5966_003_0	3	Generic	2	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								20	40	60					15	30	45					15	30	37																20				20			0.67	0.5	0.5			0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	3	0		29	10	S5966_003_0	3	Preferred Brand	2	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					45	90	135					45	90	135																47				47			1.57	1.5	1.5			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	3	0		29	10	S5966_003_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31											91.33	35	35	35				91.33	35	35	35				35	35	35															35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	3	0		29	10	S5966_003_0	3	Specialty Tier	2	11	1	1	5	1		10	1	10		1				30					30						30		31											410.71	25						410.71	25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	4	0		29	10	S5966_004_0	3	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								4	8	12					0	0	0					0	0	0																4				4			0.13	0	0			0.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	4	0		29	10	S5966_004_0	3	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								12	24	36					8	16	24					8	16	20																12				12			0.4	0.27	0.27			0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	4	0		29	10	S5966_004_0	3	Preferred Brand	4	10	1	2	3	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								47	94	141					40	80	120					40	80	120																47				47			1.57	1.33	1.33			1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	4	0		29	10	S5966_004_0	3	Non-Preferred Drug	4	11	1	2	4	1		111	1	111		1				30	60	90	1	2	30	60	90				30		31								100	200	300					95	190	285					95	190	285																100				100			3.33	3.17	3.17			3.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5966	4	0		29	10	S5966_004_0	3	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		31											339.81	28						339.81	28						28																	28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	4	0		29	10	S5983_004_0	2	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	4	0		29	10	S5983_004_0	2	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					3		9													6						6				12				12			0.4	0.1				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	4	0		29	10	S5983_004_0	2	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								35		105					25		75													75						75				35				35			1.17	0.83				1.13	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	4	0		29	10	S5983_004_0	2	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											62.68	37						64.18	35												37						37					37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	4	0		29	10	S5983_004_0	2	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	6	0		29	10	S5983_006_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	6	0		29	10	S5983_006_0	1	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					2		6													0						0				10				10			0.33	0.07				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5983	6	0		29	10	S5983_006_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	6	0		29	10	S5983_006_0	1	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								20		60					7		21													4						4				20				20			0.67	0.23				0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5983	6	0		29	10	S5983_006_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	6	0		29	10	S5983_006_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											98.48	49						82.58	47												51						49					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	6	0		29	10	S5983_006_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												28							28												28						28					28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	7	0		29	10	S5983_007_0	1	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								9		27					1		3													0						0				9				9			0.3	0.03				0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	7	0		29	10	S5983_007_0	1	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					4		12													8						8				12				12			0.4	0.13				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	7	0		29	10	S5983_007_0	1	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								39		117					30		90													90						90				39				39			1.3	1				1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	7	0		29	10	S5983_007_0	1	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											58.15	40						44.32	38												42						40					40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5983	7	0		29	10	S5983_007_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	1	0		29	10	S5993_001_0	6	Preferred Generic	2	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	1	0		29	10	S5993_001_0	6	Generic	2	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			2.5	5	7.5																5				5		0.17			0.08			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	1	0		29	10	S5993_001_0	6	Preferred Brand	2	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	28	56	84																			28	56	84																28				28		0.93			0.93			0.9	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	1	0		29	10	S5993_001_0	6	Non-Preferred Drug	2	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				55.48	40	40	40																		40	40	40															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	1	0		29	10	S5993_001_0	6	Specialty Tier	2	11	1	1	5	1	10		1			1	30														30		31				288.58	25																																					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	3	0		29	10	S5993_003_0	6	Preferred Generic	4	1	1	2	1	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	3	0		29	10	S5993_003_0	6	Preferred Generic	4	1	1	2	1	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	0	0	0																			0	0	0																0				0		0			0			0	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5993	3	0		29	10	S5993_003_0	6	Generic	4	1	1	2	2	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			2.5	5	7.5																5				5		0.17			0.08			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	3	0		29	10	S5993_003_0	6	Generic	4	1	1	2	2	3	111		1	111		1	30	60	90				1	2	30	60	90				30		31	5	10	15																			2.5	5	7.5																5				5		0.17			0.08			0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S5993	3	0		29	10	S5993_003_0	6	Preferred Brand	4	11	1	2	3	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31	40	80	120																			40	80	120																40				40		1.33			1.33			1.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	3	0		29	10	S5993_003_0	6	Non-Preferred Drug	4	11	1	1	4	1	111		1	111		1	30	60	90				1	2	30	60	90				30		31				65.89	45	45	45																		45	45	45															45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S5993	3	0		29	10	S5993_003_0	6	Specialty Tier	4	11	1	1	5	1	10		1			1	30														30		31				278.37	33																																					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	1	0		29	10	S6506_001_0	3	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								5	10	15					1	2	3											5	10	15				1	2	3				5				5			0.17	0.03		0.17	0.03	0.16	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	1	0		29	10	S6506_001_0	3	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					4	8	12											10	20	30				4	8	12				10				10			0.33	0.13		0.33	0.13	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	1	0		29	10	S6506_001_0	3	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								39	78	117					34	68	102											39	78	117				34	68	102				39				39			1.3	1.13		1.3	1.13	1.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	1	0		29	10	S6506_001_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											95.69	33	33	33				62.52	29	29	29										33	33	33				29	29	29			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	1	0		29	10	S6506_001_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	2	0		29	10	S6506_002_0	3	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	37.5					0	0	0											15	30	37.5				0	0	0				15				15			0.5	0		0.5	0	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	2	0		29	10	S6506_002_0	3	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	50					4	8	10											20	40	50				4	8	10				20				20			0.67	0.13		0.67	0.13	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	2	0		29	10	S6506_002_0	3	Preferred Brand	4	11	1	1	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											41.82	25	25	25				40.87	18	18	18										25	25	25				18	18	18			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	2	0		29	10	S6506_002_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											82.2	50	50	50				55.51	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	2	0		29	10	S6506_002_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												33							33												33						33					33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	3	0		29	10	S6506_003_0	3	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	3	0		29	10	S6506_003_0	3	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					1	2	3											15	30	45				1	2	3				15				15			0.5	0.03		0.5	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	3	0		29	10	S6506_003_0	3	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								45	90	135					30	60	90											45	90	135				30	60	90				45				45			1.5	1		1.5	1	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	3	0		29	10	S6506_003_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											89.9	44	44	44				51.36	30	30	30										44	44	44				30	30	30			44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6506	3	0		29	10	S6506_003_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	1	0		29	10	S6946_001_0	5	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	1	0		29	10	S6946_001_0	5	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	1	0		29	10	S6946_001_0	5	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	1	0		29	10	S6946_001_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	1	0		29	10	S6946_001_0	5	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	2	0		29	10	S6946_002_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				3			0.1	0.03		0.1	0.03	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	2	0		29	10	S6946_002_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				6			0.2	0.1		0.2	0.1	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	2	0		29	10	S6946_002_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				47			1.57	1.5		1.57	1.5	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	2	0		29	10	S6946_002_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	2	0		29	10	S6946_002_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	3	0		29	10	S6946_003_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	3	0		29	10	S6946_003_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	3	0		29	10	S6946_003_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	3	0		29	10	S6946_003_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	38	38	38				40	38	38	38										38	38	38				38	38	38			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	3	0		29	10	S6946_003_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	4	0		29	10	S6946_004_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	4	0		29	10	S6946_004_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	4	0		29	10	S6946_004_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	4	0		29	10	S6946_004_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	4	0		29	10	S6946_004_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	5	0		29	10	S6946_005_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	5	0		29	10	S6946_005_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	5	0		29	10	S6946_005_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	5	0		29	10	S6946_005_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	5	0		29	10	S6946_005_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	6	0		29	10	S6946_006_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	6	0		29	10	S6946_006_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	6	0		29	10	S6946_006_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	6	0		29	10	S6946_006_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	6	0		29	10	S6946_006_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	7	0		29	10	S6946_007_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	7	0		29	10	S6946_007_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	7	0		29	10	S6946_007_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	7	0		29	10	S6946_007_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	7	0		29	10	S6946_007_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	8	0		29	10	S6946_008_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	8	0		29	10	S6946_008_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	8	0		29	10	S6946_008_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	8	0		29	10	S6946_008_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	34	34	34				40	34	34	34										34	34	34				34	34	34			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	8	0		29	10	S6946_008_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	9	0		29	10	S6946_009_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	9	0		29	10	S6946_009_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	9	0		29	10	S6946_009_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	9	0		29	10	S6946_009_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	9	0		29	10	S6946_009_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	10	0		29	10	S6946_010_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	10	0		29	10	S6946_010_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	10	0		29	10	S6946_010_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	10	0		29	10	S6946_010_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	10	0		29	10	S6946_010_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	11	0		29	10	S6946_011_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	11	0		29	10	S6946_011_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	11	0		29	10	S6946_011_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	11	0		29	10	S6946_011_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	11	0		29	10	S6946_011_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	12	0		29	10	S6946_012_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	12	0		29	10	S6946_012_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	12	0		29	10	S6946_012_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	12	0		29	10	S6946_012_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	12	0		29	10	S6946_012_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	13	0		29	10	S6946_013_0	5	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	13	0		29	10	S6946_013_0	5	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	13	0		29	10	S6946_013_0	5	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	13	0		29	10	S6946_013_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	35	35	35				40	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	13	0		29	10	S6946_013_0	5	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	14	0		29	10	S6946_014_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	14	0		29	10	S6946_014_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	14	0		29	10	S6946_014_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	14	0		29	10	S6946_014_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	14	0		29	10	S6946_014_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	15	0		29	10	S6946_015_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	15	0		29	10	S6946_015_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	15	0		29	10	S6946_015_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	15	0		29	10	S6946_015_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	35	35	35				40	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	15	0		29	10	S6946_015_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	16	0		29	10	S6946_016_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	16	0		29	10	S6946_016_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	16	0		29	10	S6946_016_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	16	0		29	10	S6946_016_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	16	0		29	10	S6946_016_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	17	0		29	10	S6946_017_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	17	0		29	10	S6946_017_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	17	0		29	10	S6946_017_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	17	0		29	10	S6946_017_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	35	35	35				40	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	17	0		29	10	S6946_017_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	18	0		29	10	S6946_018_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	18	0		29	10	S6946_018_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	18	0		29	10	S6946_018_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	18	0		29	10	S6946_018_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	35	35	35				40	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	18	0		29	10	S6946_018_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	19	0		29	10	S6946_019_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	19	0		29	10	S6946_019_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	19	0		29	10	S6946_019_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	19	0		29	10	S6946_019_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	19	0		29	10	S6946_019_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	20	0		29	10	S6946_020_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	20	0		29	10	S6946_020_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	20	0		29	10	S6946_020_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	20	0		29	10	S6946_020_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	38	38	38				40	38	38	38										38	38	38				38	38	38			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	20	0		29	10	S6946_020_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	21	0		29	10	S6946_021_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	21	0		29	10	S6946_021_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	21	0		29	10	S6946_021_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	21	0		29	10	S6946_021_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	21	0		29	10	S6946_021_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	22	0		29	10	S6946_022_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	22	0		29	10	S6946_022_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	22	0		29	10	S6946_022_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	22	0		29	10	S6946_022_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	22	0		29	10	S6946_022_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	23	0		29	10	S6946_023_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	23	0		29	10	S6946_023_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	23	0		29	10	S6946_023_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	23	0		29	10	S6946_023_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	23	0		29	10	S6946_023_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	24	0		29	10	S6946_024_0	6	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	24	0		29	10	S6946_024_0	6	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	24	0		29	10	S6946_024_0	6	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	24	0		29	10	S6946_024_0	6	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	24	0		29	10	S6946_024_0	6	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	25	0		29	10	S6946_025_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	25	0		29	10	S6946_025_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	25	0		29	10	S6946_025_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	25	0		29	10	S6946_025_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	38	38	38				40	38	38	38										38	38	38				38	38	38			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	25	0		29	10	S6946_025_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	26	0		29	10	S6946_026_0	5	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	26	0		29	10	S6946_026_0	5	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	26	0		29	10	S6946_026_0	5	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	26	0		29	10	S6946_026_0	5	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	36	36	36				40	36	36	36										36	36	36				36	36	36			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	26	0		29	10	S6946_026_0	5	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	27	0		29	10	S6946_027_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	27	0		29	10	S6946_027_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	27	0		29	10	S6946_027_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	27	0		29	10	S6946_027_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	35	35	35				40	35	35	35										35	35	35				35	35	35			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	27	0		29	10	S6946_027_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	28	0		29	10	S6946_028_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	28	0		29	10	S6946_028_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	28	0		29	10	S6946_028_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	28	0		29	10	S6946_028_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	37	37	37				40	37	37	37										37	37	37				37	37	37			37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	28	0		29	10	S6946_028_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	29	0		29	10	S6946_029_0	4	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								3	6	9					1	2	3											3	6	9				1	2	3				3				1			0.1	0.03		0.1	0.03	0.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	29	0		29	10	S6946_029_0	4	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	18					3	6	9											6	12	18				3	6	9				6				3			0.2	0.1		0.2	0.1	0.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	29	0		29	10	S6946_029_0	4	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					45	90	135											47	94	141				45	90	135				47				45			1.57	1.5		1.57	1.5	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	29	0		29	10	S6946_029_0	4	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											40	34	34	34				40	34	34	34										34	34	34				34	34	34			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	29	0		29	10	S6946_029_0	4	Specialty Tier	2	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											410	25	25	25				410	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	30	0		29	10	S6946_030_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	30	0		29	10	S6946_030_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	30	0		29	10	S6946_030_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	30	0		29	10	S6946_030_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	30	0		29	10	S6946_030_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	31	0		29	10	S6946_031_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	31	0		29	10	S6946_031_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	31	0		29	10	S6946_031_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	31	0		29	10	S6946_031_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	31	0		29	10	S6946_031_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	32	0		29	10	S6946_032_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	32	0		29	10	S6946_032_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	32	0		29	10	S6946_032_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	32	0		29	10	S6946_032_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	32	0		29	10	S6946_032_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	33	0		29	10	S6946_033_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	33	0		29	10	S6946_033_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	33	0		29	10	S6946_033_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	33	0		29	10	S6946_033_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	33	0		29	10	S6946_033_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	34	0		29	10	S6946_034_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	34	0		29	10	S6946_034_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	34	0		29	10	S6946_034_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	34	0		29	10	S6946_034_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	34	0		29	10	S6946_034_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	35	0		29	10	S6946_035_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	35	0		29	10	S6946_035_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	35	0		29	10	S6946_035_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	35	0		29	10	S6946_035_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	35	0		29	10	S6946_035_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	36	0		29	10	S6946_036_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	36	0		29	10	S6946_036_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	36	0		29	10	S6946_036_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	36	0		29	10	S6946_036_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	36	0		29	10	S6946_036_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	37	0		29	10	S6946_037_0	5	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	37	0		29	10	S6946_037_0	5	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	37	0		29	10	S6946_037_0	5	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	37	0		29	10	S6946_037_0	5	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	37	0		29	10	S6946_037_0	5	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	38	0		29	10	S6946_038_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	38	0		29	10	S6946_038_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	38	0		29	10	S6946_038_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	38	0		29	10	S6946_038_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	38	0		29	10	S6946_038_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	39	0		29	10	S6946_039_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	39	0		29	10	S6946_039_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	39	0		29	10	S6946_039_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	39	0		29	10	S6946_039_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	39	0		29	10	S6946_039_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	40	0		29	10	S6946_040_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	40	0		29	10	S6946_040_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	40	0		29	10	S6946_040_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	40	0		29	10	S6946_040_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	40	0		29	10	S6946_040_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	41	0		29	10	S6946_041_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	41	0		29	10	S6946_041_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	41	0		29	10	S6946_041_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	41	0		29	10	S6946_041_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	41	0		29	10	S6946_041_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	42	0		29	10	S6946_042_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	42	0		29	10	S6946_042_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	42	0		29	10	S6946_042_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	42	0		29	10	S6946_042_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	42	0		29	10	S6946_042_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	43	0		29	10	S6946_043_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	43	0		29	10	S6946_043_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	43	0		29	10	S6946_043_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	43	0		29	10	S6946_043_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	43	0		29	10	S6946_043_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	44	0		29	10	S6946_044_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	44	0		29	10	S6946_044_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	44	0		29	10	S6946_044_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	44	0		29	10	S6946_044_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	44	0		29	10	S6946_044_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	45	0		29	10	S6946_045_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	45	0		29	10	S6946_045_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	45	0		29	10	S6946_045_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	45	0		29	10	S6946_045_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	45	0		29	10	S6946_045_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	46	0		29	10	S6946_046_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	46	0		29	10	S6946_046_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	46	0		29	10	S6946_046_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	46	0		29	10	S6946_046_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	46	0		29	10	S6946_046_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	47	0		29	10	S6946_047_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	47	0		29	10	S6946_047_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	47	0		29	10	S6946_047_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	47	0		29	10	S6946_047_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	47	0		29	10	S6946_047_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	48	0		29	10	S6946_048_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	48	0		29	10	S6946_048_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	48	0		29	10	S6946_048_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	48	0		29	10	S6946_048_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	48	0		29	10	S6946_048_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	49	0		29	10	S6946_049_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	49	0		29	10	S6946_049_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	49	0		29	10	S6946_049_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	49	0		29	10	S6946_049_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	49	0		29	10	S6946_049_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	50	0		29	10	S6946_050_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	50	0		29	10	S6946_050_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	50	0		29	10	S6946_050_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	50	0		29	10	S6946_050_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	50	0		29	10	S6946_050_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	51	0		29	10	S6946_051_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	51	0		29	10	S6946_051_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	51	0		29	10	S6946_051_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	51	0		29	10	S6946_051_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	51	0		29	10	S6946_051_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	52	0		29	10	S6946_052_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	52	0		29	10	S6946_052_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	52	0		29	10	S6946_052_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	52	0		29	10	S6946_052_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	52	0		29	10	S6946_052_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	53	0		29	10	S6946_053_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	53	0		29	10	S6946_053_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	53	0		29	10	S6946_053_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	53	0		29	10	S6946_053_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	53	0		29	10	S6946_053_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	54	0		29	10	S6946_054_0	6	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	54	0		29	10	S6946_054_0	6	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	54	0		29	10	S6946_054_0	6	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	54	0		29	10	S6946_054_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	54	0		29	10	S6946_054_0	6	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	55	0		29	10	S6946_055_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	55	0		29	10	S6946_055_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	55	0		29	10	S6946_055_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	55	0		29	10	S6946_055_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	55	0		29	10	S6946_055_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	56	0		29	10	S6946_056_0	6	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	56	0		29	10	S6946_056_0	6	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	56	0		29	10	S6946_056_0	6	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	56	0		29	10	S6946_056_0	6	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	56	0		29	10	S6946_056_0	6	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	57	0		29	10	S6946_057_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	57	0		29	10	S6946_057_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	57	0		29	10	S6946_057_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	57	0		29	10	S6946_057_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	57	0		29	10	S6946_057_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	58	0		29	10	S6946_058_0	4	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					1	2	3											10	20	30				1	2	3				10				10			0.33	0.03		0.33	0.03	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	58	0		29	10	S6946_058_0	4	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								20	40	60					3	6	9											20	40	60				3	6	9				20				20			0.67	0.1		0.67	0.1	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	58	0		29	10	S6946_058_0	4	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					40	80	120											47	94	141				40	80	120				47				47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	58	0		29	10	S6946_058_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											55	50	50	50				55	40	40	40										50	50	50				40	40	40			50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6946	58	0		29	10	S6946_058_0	4	Specialty Tier	4	11	1	1	5	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											280	25	25	25				280	25	25	25										25	25	25				25	25	25			25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	1	0		29	10	S6986_001_0	2	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					2	4	4											6	12	12				2	4	4				6				6			0.2	0.07		0.2	0.07	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	1	0		29	10	S6986_001_0	2	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					6	12	12											10	20	20				6	12	12				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	1	0		29	10	S6986_001_0	2	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								31	62	93					25	50	75											31	62	93				25	50	75				31				31			1.03	0.83		1.03	0.83	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	1	0		29	10	S6986_001_0	2	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											80.71	33	33	33				75.27	29	29	29										33	33	33				29	29	29			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	1	0		29	10	S6986_001_0	2	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	2	0		29	10	S6986_002_0	2	Preferred Generic	3	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					3	6	6											10	20	20				3	6	6				10				10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	2	0		29	10	S6986_002_0	2	Generic	3	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	30					7	14	14											15	30	30				7	14	14				15				15			0.5	0.23		0.5	0.23	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	2	0		29	10	S6986_002_0	2	Preferred Brand	3	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								44	88	132					25	50	75											44	88	132				25	50	75				44				44			1.47	0.83		1.47	0.83	1.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	2	0		29	10	S6986_002_0	2	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											98.85	33	33	33				74.05	29	29	29										33	33	33				29	29	29			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	2	0		29	10	S6986_002_0	2	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	3	0		29	10	S6986_003_0	1	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					2	4	4											6	12	12				2	4	4				6				6			0.2	0.07		0.2	0.07	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	3	0		29	10	S6986_003_0	1	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					6	12	12											10	20	20				6	12	12				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	3	0		29	10	S6986_003_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					25	50	75											47	94	141				25	50	75				47				47			1.57	0.83		1.57	0.83	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	3	0		29	10	S6986_003_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											89.57	34	34	34				73.19	29	29	29										34	34	34				29	29	29			34			34								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	3	0		29	10	S6986_003_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	4	0		29	10	S6986_004_0	1	Preferred Generic	3	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					0	0	0											10	20	20				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	4	0		29	10	S6986_004_0	1	Generic	3	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	30					1	2	2											15	30	30				1	2	2				15				15			0.5	0.03		0.5	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	4	0		29	10	S6986_004_0	1	Preferred Brand	3	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					30	60	90											47	94	141				30	60	90				47				47			1.57	1		1.57	1	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	4	0		29	10	S6986_004_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											90.98	36	36	36				81.99	30	30	30										36	36	36				30	30	30			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	4	0		29	10	S6986_004_0	1	Specialty Tier	3	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	6	0		29	10	S6986_006_0	1	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					2	4	4											6	12	12				2	4	4				6				6			0.2	0.07		0.2	0.07	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	6	0		29	10	S6986_006_0	1	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					6	12	12											10	20	20				6	12	12				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	6	0		29	10	S6986_006_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								31	62	93					25	50	75											31	62	93				25	50	75				31				31			1.03	0.83		1.03	0.83	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	6	0		29	10	S6986_006_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											81.43	33	33	33				78.7	29	29	29										33	33	33				29	29	29			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	6	0		29	10	S6986_006_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	7	0		29	10	S6986_007_0	1	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					2	4	4											6	12	12				2	4	4				6				6			0.2	0.07		0.2	0.07	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	7	0		29	10	S6986_007_0	1	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					6	12	12											10	20	20				6	12	12				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	7	0		29	10	S6986_007_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								31	62	93					25	50	75											31	62	93				25	50	75				31				31			1.03	0.83		1.03	0.83	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	7	0		29	10	S6986_007_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											81.01	33	33	33				76.68	29	29	29										33	33	33				29	29	29			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	7	0		29	10	S6986_007_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	8	0		29	10	S6986_008_0	2	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	8	0		29	10	S6986_008_0	2	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					1	2	3											15	30	45				1	2	3				15				15			0.5	0.03		0.5	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	8	0		29	10	S6986_008_0	2	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	8	0		29	10	S6986_008_0	2	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											96.27	45	45	45				60.91	33	33	33										45	45	45				33	33	33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	8	0		29	10	S6986_008_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	10	0		29	10	S6986_010_0	1	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	10	0		29	10	S6986_010_0	1	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					1	2	3											15	30	45				1	2	3				15				15			0.5	0.03		0.5	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	10	0		29	10	S6986_010_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	10	0		29	10	S6986_010_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											94.74	45	45	45				59.98	33	33	33										45	45	45				33	33	33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	10	0		29	10	S6986_010_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	12	0		29	10	S6986_012_0	1	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	12	0		29	10	S6986_012_0	1	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					1	2	3											15	30	45				1	2	3				15				15			0.5	0.03		0.5	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	12	0		29	10	S6986_012_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	12	0		29	10	S6986_012_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											98.62	45	45	45				62.39	33	33	33										45	45	45				33	33	33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	12	0		29	10	S6986_012_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	13	0		29	10	S6986_013_0	1	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	13	0		29	10	S6986_013_0	1	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					1	2	3											15	30	45				1	2	3				15				15			0.5	0.03		0.5	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	13	0		29	10	S6986_013_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	13	0		29	10	S6986_013_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											96.18	45	45	45				60.86	33	33	33										45	45	45				33	33	33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	13	0		29	10	S6986_013_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	14	0		29	10	S6986_014_0	1	Preferred Generic	2	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								6	12	12					2	4	4											6	12	12				2	4	4				6				6			0.2	0.07		0.2	0.07	0.19	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	14	0		29	10	S6986_014_0	1	Generic	2	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	20					6	12	12											10	20	20				6	12	12				10				10			0.33	0.2		0.33	0.2	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	14	0		29	10	S6986_014_0	1	Preferred Brand	2	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								31	62	93					25	50	75											31	62	93				25	50	75				31				31			1.03	0.83		1.03	0.83	1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	14	0		29	10	S6986_014_0	1	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											81.28	33	33	33				77.99	29	29	29										33	33	33				29	29	29			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	14	0		29	10	S6986_014_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	15	0		29	10	S6986_015_0	1	Preferred Generic	4	11	1	2	1	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								10	20	30					0	0	0											10	20	30				0	0	0				10				10			0.33	0		0.33	0	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	15	0		29	10	S6986_015_0	1	Generic	4	11	1	2	2	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								15	30	45					1	2	3											15	30	45				1	2	3				15				15			0.5	0.03		0.5	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	15	0		29	10	S6986_015_0	1	Preferred Brand	4	11	1	2	3	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31								47	94	141					35	70	105											47	94	141				35	70	105				47				47			1.57	1.17		1.57	1.17	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	15	0		29	10	S6986_015_0	1	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				30	60	90	1	2				30	60	90	30		31											95.45	45	45	45				60.41	33	33	33										45	45	45				33	33	33			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S6986	15	0		29	10	S6986_015_0	1	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	1	0		29	10	S7126_001_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	1	0		29	10	S7126_001_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													24						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	1	0		29	10	S7126_001_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	1	0		29	10	S7126_001_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											54.22	50						50.39	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	1	0		29	10	S7126_001_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	2	0		29	10	S7126_002_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	2	0		29	10	S7126_002_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								18		54					12		36													36						36				18				18			0.6	0.4				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	2	0		29	10	S7126_002_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	2	0		29	10	S7126_002_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											49.49	50						52.02	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	2	0		29	10	S7126_002_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	3	0		29	10	S7126_003_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	3	0		29	10	S7126_003_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								17		51					11		33													33						33				17				17			0.57	0.37				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	3	0		29	10	S7126_003_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	3	0		29	10	S7126_003_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											55.15	50						52.6	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	3	0		29	10	S7126_003_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	4	0		29	10	S7126_004_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	4	0		29	10	S7126_004_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					9		27													27						27				15				15			0.5	0.3				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	4	0		29	10	S7126_004_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	4	0		29	10	S7126_004_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											53.31	50						49.93	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	4	0		29	10	S7126_004_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	5	0		29	10	S7126_005_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	5	0		29	10	S7126_005_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					9		27													27						27				15				15			0.5	0.3				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	5	0		29	10	S7126_005_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	5	0		29	10	S7126_005_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											54.1	50						50.3	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	5	0		29	10	S7126_005_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	6	0		29	10	S7126_006_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	6	0		29	10	S7126_006_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								16		48					10		30													30						30				16				16			0.53	0.33				0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	6	0		29	10	S7126_006_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	6	0		29	10	S7126_006_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.01	50						51.95	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	6	0		29	10	S7126_006_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	7	0		29	10	S7126_007_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	7	0		29	10	S7126_007_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													24						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	7	0		29	10	S7126_007_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	7	0		29	10	S7126_007_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											52.56	50						49.34	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	7	0		29	10	S7126_007_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	8	0		29	10	S7126_008_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	8	0		29	10	S7126_008_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								17		51					11		33													33						33				17				17			0.57	0.37				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	8	0		29	10	S7126_008_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	8	0		29	10	S7126_008_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											50.16	50						53.03	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	8	0		29	10	S7126_008_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	9	0		29	10	S7126_009_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	9	0		29	10	S7126_009_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					9		27													27						27				15				15			0.5	0.3				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	9	0		29	10	S7126_009_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	9	0		29	10	S7126_009_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											52.36	50						50.91	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	9	0		29	10	S7126_009_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	10	0		29	10	S7126_010_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	10	0		29	10	S7126_010_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								16		48					10		30													30						30				16				16			0.53	0.33				0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	10	0		29	10	S7126_010_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	10	0		29	10	S7126_010_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.77	50						52.08	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	10	0		29	10	S7126_010_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	11	0		29	10	S7126_011_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	11	0		29	10	S7126_011_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													24						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	11	0		29	10	S7126_011_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	11	0		29	10	S7126_011_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											52.65	50						49.65	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	11	0		29	10	S7126_011_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	12	0		29	10	S7126_012_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	12	0		29	10	S7126_012_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													24						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	12	0		29	10	S7126_012_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	12	0		29	10	S7126_012_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											52.43	50						49.8	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	12	0		29	10	S7126_012_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	13	0		29	10	S7126_013_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	13	0		29	10	S7126_013_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								16		48					10		30													30						30				16				16			0.53	0.33				0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	13	0		29	10	S7126_013_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	13	0		29	10	S7126_013_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											49.91	50						50.46	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	13	0		29	10	S7126_013_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	14	0		29	10	S7126_014_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	14	0		29	10	S7126_014_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													24						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	14	0		29	10	S7126_014_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	14	0		29	10	S7126_014_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											47.62	50						48.56	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	14	0		29	10	S7126_014_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	15	0		29	10	S7126_015_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	15	0		29	10	S7126_015_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								11		33					5		15													15						15				11				11			0.37	0.17				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	15	0		29	10	S7126_015_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	15	0		29	10	S7126_015_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											50.44	50						47.57	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	15	0		29	10	S7126_015_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	16	0		29	10	S7126_016_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	16	0		29	10	S7126_016_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					9		27													27						27				15				15			0.5	0.3				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	16	0		29	10	S7126_016_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	16	0		29	10	S7126_016_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.37	50						49.82	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	16	0		29	10	S7126_016_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	17	0		29	10	S7126_017_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	17	0		29	10	S7126_017_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					6		18													18						18				12				12			0.4	0.2				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	17	0		29	10	S7126_017_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	17	0		29	10	S7126_017_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.41	50						47.95	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	17	0		29	10	S7126_017_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	18	0		29	10	S7126_018_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	18	0		29	10	S7126_018_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								11		33					5		15													15						15				11				11			0.37	0.17				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	18	0		29	10	S7126_018_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								45		135					40		120													120						120				45				45			1.5	1.33				1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	18	0		29	10	S7126_018_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											50.32	50						46.74	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	18	0		29	10	S7126_018_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	19	0		29	10	S7126_019_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	19	0		29	10	S7126_019_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					6		18													18						18				12				12			0.4	0.2				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	19	0		29	10	S7126_019_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	19	0		29	10	S7126_019_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											53.28	50						48.53	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	19	0		29	10	S7126_019_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	20	0		29	10	S7126_020_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	20	0		29	10	S7126_020_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								13		39					7		21													21						21				13				13			0.43	0.23				0.42	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	20	0		29	10	S7126_020_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	20	0		29	10	S7126_020_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											53.63	50						48.96	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	20	0		29	10	S7126_020_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	21	0		29	10	S7126_021_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	21	0		29	10	S7126_021_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								16		48					10		30													30						30				16				16			0.53	0.33				0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	21	0		29	10	S7126_021_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	21	0		29	10	S7126_021_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											50.94	50						50.81	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	21	0		29	10	S7126_021_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	22	0		29	10	S7126_022_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	22	0		29	10	S7126_022_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					6		18													18						18				12				12			0.4	0.2				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	22	0		29	10	S7126_022_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	22	0		29	10	S7126_022_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.91	50						49.17	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	22	0		29	10	S7126_022_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	23	0		29	10	S7126_023_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	23	0		29	10	S7126_023_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					6		18													18						18				12				12			0.4	0.2				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	23	0		29	10	S7126_023_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	23	0		29	10	S7126_023_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											49.2	50						46.01	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	23	0		29	10	S7126_023_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	24	0		29	10	S7126_024_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	24	0		29	10	S7126_024_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								11		33					5		15													15						15				11				11			0.37	0.17				0.35	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	24	0		29	10	S7126_024_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	24	0		29	10	S7126_024_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											49.8	50						47.09	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	24	0		29	10	S7126_024_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	25	0		29	10	S7126_025_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	25	0		29	10	S7126_025_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								14		42					8		24													24						24				14				14			0.47	0.27				0.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	25	0		29	10	S7126_025_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	25	0		29	10	S7126_025_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											54.27	50						51.44	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	25	0		29	10	S7126_025_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	26	0		29	10	S7126_026_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	26	0		29	10	S7126_026_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								16		48					10		30													30						30				16				16			0.53	0.33				0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	26	0		29	10	S7126_026_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	26	0		29	10	S7126_026_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											50.9	50						51.31	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	26	0		29	10	S7126_026_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	27	0		29	10	S7126_027_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	27	0		29	10	S7126_027_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								17		51					11		33													33						33				17				17			0.57	0.37				0.55	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	27	0		29	10	S7126_027_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	27	0		29	10	S7126_027_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											47.82	50						50.8	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	27	0		29	10	S7126_027_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	28	0		29	10	S7126_028_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	28	0		29	10	S7126_028_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					9		27													27						27				15				15			0.5	0.3				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	28	0		29	10	S7126_028_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	28	0		29	10	S7126_028_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											48.5	50						50.09	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	28	0		29	10	S7126_028_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	29	0		29	10	S7126_029_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	29	0		29	10	S7126_029_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					6		18													18						18				12				12			0.4	0.2				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	29	0		29	10	S7126_029_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	29	0		29	10	S7126_029_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.76	50						49.91	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	29	0		29	10	S7126_029_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	30	0		29	10	S7126_030_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	30	0		29	10	S7126_030_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					6		18													18						18				12				12			0.4	0.2				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	30	0		29	10	S7126_030_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	30	0		29	10	S7126_030_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											50.26	50						47.86	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	30	0		29	10	S7126_030_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	31	0		29	10	S7126_031_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	31	0		29	10	S7126_031_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								16		48					10		30													30						30				16				16			0.53	0.33				0.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	31	0		29	10	S7126_031_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	31	0		29	10	S7126_031_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											53.77	50						50.3	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	31	0		29	10	S7126_031_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	32	0		29	10	S7126_032_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	32	0		29	10	S7126_032_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								18		54					12		36													36						36				18				18			0.6	0.4				0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	32	0		29	10	S7126_032_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	32	0		29	10	S7126_032_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											51.75	50						53.17	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	32	0		29	10	S7126_032_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	33	0		29	10	S7126_033_0	1	Preferred Generic	2	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								8		24					0		0													0						0				8				8			0.27	0				0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	33	0		29	10	S7126_033_0	1	Generic	2	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								12		36					6		18													18						18				12				12			0.4	0.2				0.39	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	33	0		29	10	S7126_033_0	1	Preferred Brand	2	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								47		141					42		126													126						126				47				47			1.57	1.4				1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	33	0		29	10	S7126_033_0	1	Non-Preferred Drug	2	11	1	1	4	1		10	1		10	1				30								30			30		31											53.34	50						50.49	48												48						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	33	0		29	10	S7126_033_0	1	Specialty Tier	2	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	34	0		29	10	S7126_034_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	34	0		29	10	S7126_034_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	34	0		29	10	S7126_034_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	34	0		29	10	S7126_034_0	3	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	34	0		29	10	S7126_034_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	34	0		29	10	S7126_034_0	3	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											78.87	47						72.09	45												47						45					47			47								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	34	0		29	10	S7126_034_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	35	0		29	10	S7126_035_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	35	0		29	10	S7126_035_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	35	0		29	10	S7126_035_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	35	0		29	10	S7126_035_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	35	0		29	10	S7126_035_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	35	0		29	10	S7126_035_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											88.96	50						78.01	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	35	0		29	10	S7126_035_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	36	0		29	10	S7126_036_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	36	0		29	10	S7126_036_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	36	0		29	10	S7126_036_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	36	0		29	10	S7126_036_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	36	0		29	10	S7126_036_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								33		99					28		84													84						84				33				33			1.1	0.93				1.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	36	0		29	10	S7126_036_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											88.28	50						79.24	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	36	0		29	10	S7126_036_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	37	0		29	10	S7126_037_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	37	0		29	10	S7126_037_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	37	0		29	10	S7126_037_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	37	0		29	10	S7126_037_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	37	0		29	10	S7126_037_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	37	0		29	10	S7126_037_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											83.43	49						75.14	47												49						47					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	37	0		29	10	S7126_037_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	38	0		29	10	S7126_038_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	38	0		29	10	S7126_038_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	38	0		29	10	S7126_038_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	38	0		29	10	S7126_038_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	38	0		29	10	S7126_038_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	38	0		29	10	S7126_038_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											83.05	50						75.94	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	38	0		29	10	S7126_038_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	39	0		29	10	S7126_039_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	39	0		29	10	S7126_039_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	39	0		29	10	S7126_039_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	39	0		29	10	S7126_039_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	39	0		29	10	S7126_039_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								32		96					27		81													81						81				32				32			1.07	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	39	0		29	10	S7126_039_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											84.11	50						72.33	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	39	0		29	10	S7126_039_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	40	0		29	10	S7126_040_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	40	0		29	10	S7126_040_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	40	0		29	10	S7126_040_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	40	0		29	10	S7126_040_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	40	0		29	10	S7126_040_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	40	0		29	10	S7126_040_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											77.43	49						71.16	47												49						47					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	40	0		29	10	S7126_040_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	41	0		29	10	S7126_041_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	41	0		29	10	S7126_041_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	41	0		29	10	S7126_041_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	41	0		29	10	S7126_041_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	41	0		29	10	S7126_041_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								32		96					27		81													81						81				32				32			1.07	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	41	0		29	10	S7126_041_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											84.47	50						72.13	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	41	0		29	10	S7126_041_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	42	0		29	10	S7126_042_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	42	0		29	10	S7126_042_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	42	0		29	10	S7126_042_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	42	0		29	10	S7126_042_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	42	0		29	10	S7126_042_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	42	0		29	10	S7126_042_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											79.92	49						69.08	47												49						47					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	42	0		29	10	S7126_042_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	43	0		29	10	S7126_043_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	43	0		29	10	S7126_043_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	43	0		29	10	S7126_043_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	43	0		29	10	S7126_043_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	43	0		29	10	S7126_043_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	43	0		29	10	S7126_043_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											84.81	50						74.97	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	43	0		29	10	S7126_043_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	44	0		29	10	S7126_044_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	44	0		29	10	S7126_044_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	44	0		29	10	S7126_044_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	44	0		29	10	S7126_044_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	44	0		29	10	S7126_044_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	44	0		29	10	S7126_044_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											73.25	48						67.95	46												48						46					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	44	0		29	10	S7126_044_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	45	0		29	10	S7126_045_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	45	0		29	10	S7126_045_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	45	0		29	10	S7126_045_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	45	0		29	10	S7126_045_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	45	0		29	10	S7126_045_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	45	0		29	10	S7126_045_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											75.53	46						70.13	44												46						44					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	45	0		29	10	S7126_045_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	46	0		29	10	S7126_046_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	46	0		29	10	S7126_046_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	46	0		29	10	S7126_046_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	46	0		29	10	S7126_046_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	46	0		29	10	S7126_046_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								32		96					27		81													81						81				32				32			1.07	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	46	0		29	10	S7126_046_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											82.18	50						72.71	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	46	0		29	10	S7126_046_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	47	0		29	10	S7126_047_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	47	0		29	10	S7126_047_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	47	0		29	10	S7126_047_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	47	0		29	10	S7126_047_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	47	0		29	10	S7126_047_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	47	0		29	10	S7126_047_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											76.69	49						65.56	47												49						47					49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	47	0		29	10	S7126_047_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	48	0		29	10	S7126_048_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	48	0		29	10	S7126_048_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	48	0		29	10	S7126_048_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	48	0		29	10	S7126_048_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	48	0		29	10	S7126_048_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	48	0		29	10	S7126_048_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											67.4	44						58.06	42												44						42					44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	48	0		29	10	S7126_048_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	49	0		29	10	S7126_049_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	49	0		29	10	S7126_049_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	49	0		29	10	S7126_049_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	49	0		29	10	S7126_049_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	49	0		29	10	S7126_049_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	49	0		29	10	S7126_049_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											82.06	50						72.21	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	49	0		29	10	S7126_049_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	50	0		29	10	S7126_050_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	50	0		29	10	S7126_050_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	50	0		29	10	S7126_050_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	50	0		29	10	S7126_050_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	50	0		29	10	S7126_050_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	50	0		29	10	S7126_050_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											67.4	45						60.82	43												45						43					45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	50	0		29	10	S7126_050_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	51	0		29	10	S7126_051_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	51	0		29	10	S7126_051_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	51	0		29	10	S7126_051_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	51	0		29	10	S7126_051_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	51	0		29	10	S7126_051_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	51	0		29	10	S7126_051_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											61.3	41						53.56	39												41						39					41			41								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	51	0		29	10	S7126_051_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	52	0		29	10	S7126_052_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	52	0		29	10	S7126_052_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	52	0		29	10	S7126_052_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	52	0		29	10	S7126_052_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	52	0		29	10	S7126_052_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	52	0		29	10	S7126_052_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											68.74	46						63.79	44												46						44					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	52	0		29	10	S7126_052_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	53	0		29	10	S7126_053_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	53	0		29	10	S7126_053_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	53	0		29	10	S7126_053_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	53	0		29	10	S7126_053_0	3	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	53	0		29	10	S7126_053_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	53	0		29	10	S7126_053_0	3	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											68.7	45						63.11	43												45						43					45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	53	0		29	10	S7126_053_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	54	0		29	10	S7126_054_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	54	0		29	10	S7126_054_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	54	0		29	10	S7126_054_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	54	0		29	10	S7126_054_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	54	0		29	10	S7126_054_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								31		93					26		78													78						78				31				31			1.03	0.87				1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	54	0		29	10	S7126_054_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											85.08	50						74.53	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	54	0		29	10	S7126_054_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	55	0		29	10	S7126_055_0	3	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	55	0		29	10	S7126_055_0	3	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	55	0		29	10	S7126_055_0	3	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	55	0		29	10	S7126_055_0	3	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	55	0		29	10	S7126_055_0	3	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	55	0		29	10	S7126_055_0	3	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											69.14	45						62	43												45						43					45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	55	0		29	10	S7126_055_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	56	0		29	10	S7126_056_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	56	0		29	10	S7126_056_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	56	0		29	10	S7126_056_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	56	0		29	10	S7126_056_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	56	0		29	10	S7126_056_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	56	0		29	10	S7126_056_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											71.19	48						64.12	46												48						46					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	56	0		29	10	S7126_056_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	57	0		29	10	S7126_057_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	57	0		29	10	S7126_057_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	57	0		29	10	S7126_057_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	57	0		29	10	S7126_057_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	57	0		29	10	S7126_057_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	57	0		29	10	S7126_057_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											67.11	43						58.68	41												43						41					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	57	0		29	10	S7126_057_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	58	0		29	10	S7126_058_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	58	0		29	10	S7126_058_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	58	0		29	10	S7126_058_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	58	0		29	10	S7126_058_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	58	0		29	10	S7126_058_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	58	0		29	10	S7126_058_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											76.42	44						68.35	42												44						42					44			44								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	58	0		29	10	S7126_058_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	59	0		29	10	S7126_059_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	59	0		29	10	S7126_059_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	59	0		29	10	S7126_059_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	59	0		29	10	S7126_059_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	59	0		29	10	S7126_059_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								32		96					27		81													81						81				32				32			1.07	0.9				1.03	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	59	0		29	10	S7126_059_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											86.49	50						75.69	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	59	0		29	10	S7126_059_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	60	0		29	10	S7126_060_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	60	0		29	10	S7126_060_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	60	0		29	10	S7126_060_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	60	0		29	10	S7126_060_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	60	0		29	10	S7126_060_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								34		102					29		87													87						87				34				34			1.13	0.97				1.1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	60	0		29	10	S7126_060_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											86.91	50						74.33	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	60	0		29	10	S7126_060_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	61	0		29	10	S7126_061_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	61	0		29	10	S7126_061_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	61	0		29	10	S7126_061_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	61	0		29	10	S7126_061_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	61	0		29	10	S7126_061_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	61	0		29	10	S7126_061_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											82.83	50						72.21	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	61	0		29	10	S7126_061_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	62	0		29	10	S7126_062_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	62	0		29	10	S7126_062_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	62	0		29	10	S7126_062_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	62	0		29	10	S7126_062_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	62	0		29	10	S7126_062_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	62	0		29	10	S7126_062_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											75.57	45						66.35	43												45						43					45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	62	0		29	10	S7126_062_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	63	0		29	10	S7126_063_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	63	0		29	10	S7126_063_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	63	0		29	10	S7126_063_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	63	0		29	10	S7126_063_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	63	0		29	10	S7126_063_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	63	0		29	10	S7126_063_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											71.8	46						65.05	44												46						44					46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	63	0		29	10	S7126_063_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	64	0		29	10	S7126_064_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	64	0		29	10	S7126_064_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	64	0		29	10	S7126_064_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	64	0		29	10	S7126_064_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	64	0		29	10	S7126_064_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	64	0		29	10	S7126_064_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											83.07	48						73.85	46												48						46					48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	64	0		29	10	S7126_064_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	65	0		29	10	S7126_065_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	65	0		29	10	S7126_065_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	65	0		29	10	S7126_065_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	65	0		29	10	S7126_065_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	65	0		29	10	S7126_065_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	65	0		29	10	S7126_065_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											91.03	50						78.69	48												50						48					50			50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	65	0		29	10	S7126_065_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	66	0		29	10	S7126_066_0	2	Preferred Generic	4	1	1	2	1	1		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	66	0		29	10	S7126_066_0	2	Preferred Generic	4	1	1	2	1	3		110	1		100	1				30		90	1	2						90	30		31								10		30					0		0													0						0				10				10			0.33	0				0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	66	0		29	10	S7126_066_0	2	Generic	4	1	1	2	2	1		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	66	0		29	10	S7126_066_0	2	Generic	4	1	1	2	2	3		110	1		100	1				30		90	1	2						90	30		31								15		45					2		6													6						6				15				15			0.5	0.07				0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S7126	66	0		29	10	S7126_066_0	2	Preferred Brand	4	11	1	2	3	1		110	1		100	1				30		90	1	2						90	30		31								30		90					25		75													75						75				30				30			1	0.83				0.97	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	66	0		29	10	S7126_066_0	2	Non-Preferred Drug	4	11	1	1	4	1		10	1		10	1				30								30			30		31											70.18	43						62.97	41												43						41					43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7126	66	0		29	10	S7126_066_0	2	Specialty Tier	4	11	1	1	5	1		10	1		10	1				30								30			30		31												25							25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	1	0		29	10	S7694_001_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	1	0		29	10	S7694_001_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	1	0		29	10	S7694_001_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					42	84	126											47	94	117.5				42	84	105				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	1	0		29	10	S7694_001_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											60.74	46	46	46				53.91	37	37	37										46	46	46				37	37	37			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	1	0		29	10	S7694_001_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											658.2	25						658.2	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	2	0		29	10	S7694_002_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	2	0		29	10	S7694_002_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	2	0		29	10	S7694_002_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	2	0		29	10	S7694_002_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											63.75	49	49	49				66.87	44	44	44										49	49	49				44	44	44			49			49								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	2	0		29	10	S7694_002_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											609.92	25						609.92	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	3	0		29	10	S7694_003_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	3	0		29	10	S7694_003_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	3	0		29	10	S7694_003_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											39.33	20	20	20				29.55	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	3	0		29	10	S7694_003_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											53.41	33	33	33				45.55	30	30	30										33	33	33				30	30	30			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	3	0		29	10	S7694_003_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											573.87	25						573.87	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	4	0		29	10	S7694_004_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	4	0		29	10	S7694_004_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	4	0		29	10	S7694_004_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											35.15	20	20	20				26.04	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	4	0		29	10	S7694_004_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											53.86	32	32	32				43.23	29	29	29										32	32	32				29	29	29			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	4	0		29	10	S7694_004_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											643.1	25						643.1	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	5	0		29	10	S7694_005_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	5	0		29	10	S7694_005_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	5	0		29	10	S7694_005_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											40.8	20	20	20				30.33	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	5	0		29	10	S7694_005_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											50.46	35	35	35				45.28	32	32	32										35	35	35				32	32	32			35			35								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	5	0		29	10	S7694_005_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											566.34	25						566.34	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	6	0		29	10	S7694_006_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	6	0		29	10	S7694_006_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	20				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	6	0		29	10	S7694_006_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	6	0		29	10	S7694_006_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											58.86	43	43	43				49.74	35	35	35										43	43	43				35	35	35			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	6	0		29	10	S7694_006_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											655.83	25						655.83	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	7	0		29	10	S7694_007_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	7	0		29	10	S7694_007_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	7	0		29	10	S7694_007_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	7	0		29	10	S7694_007_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											62.62	46	46	46				59.45	39	39	39										46	46	46				39	39	39			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	7	0		29	10	S7694_007_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											649.77	25						649.77	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	8	0		29	10	S7694_008_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	8	0		29	10	S7694_008_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	8	0		29	10	S7694_008_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	8	0		29	10	S7694_008_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											64.43	48	48	48				66.09	43	43	43										48	48	48				43	43	43			48			48								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	8	0		29	10	S7694_008_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											688.74	25						688.74	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	9	0		29	10	S7694_009_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	9	0		29	10	S7694_009_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	9	0		29	10	S7694_009_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											34.75	20	20	20				26.46	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	9	0		29	10	S7694_009_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											45.77	32	32	32				46.76	29	29	29										32	32	32				29	29	29			32			32								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	9	0		29	10	S7694_009_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											621.7	25						621.7	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	10	0		29	10	S7694_010_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	10	0		29	10	S7694_010_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	10	0		29	10	S7694_010_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	10	0		29	10	S7694_010_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											52.68	40	40	40				45.46	33	33	33										40	40	40				33	33	33			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	10	0		29	10	S7694_010_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											574.18	25						574.18	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	11	0		29	10	S7694_011_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	11	0		29	10	S7694_011_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	11	0		29	10	S7694_011_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											31.21	20	20	20				22.06	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	11	0		29	10	S7694_011_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											47.99	31	31	31				36.01	27	27	27										31	31	31				27	27	27			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	11	0		29	10	S7694_011_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											568.08	25						568.08	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	12	0		29	10	S7694_012_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	12	0		29	10	S7694_012_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	12	0		29	10	S7694_012_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	12	0		29	10	S7694_012_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											57.74	45	45	45				57.9	40	40	40										45	45	45				40	40	40			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	12	0		29	10	S7694_012_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											651.56	25						651.56	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	14	0		29	10	S7694_014_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	14	0		29	10	S7694_014_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	14	0		29	10	S7694_014_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	14	0		29	10	S7694_014_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											54.27	39	39	39				46.04	32	32	32										39	39	39				32	32	32			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	14	0		29	10	S7694_014_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											628.77	25						628.77	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	15	0		29	10	S7694_015_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	15	0		29	10	S7694_015_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	15	0		29	10	S7694_015_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	15	0		29	10	S7694_015_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											61.83	45	45	45				57.09	38	38	38										45	45	45				38	38	38			45			45								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	15	0		29	10	S7694_015_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											654.45	25						654.45	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	16	0		29	10	S7694_016_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	16	0		29	10	S7694_016_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	16	0		29	10	S7694_016_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											37.42	20	20	20				28.08	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	16	0		29	10	S7694_016_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											43.07	28	28	28				34.38	25	25	25										28	28	28				25	25	25			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	16	0		29	10	S7694_016_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											612.67	25						612.67	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	17	0		29	10	S7694_017_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	17	0		29	10	S7694_017_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	17	0		29	10	S7694_017_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											36.31	20	20	20				25.54	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	17	0		29	10	S7694_017_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											47.51	29	29	29				36.61	26	26	26										29	29	29				26	26	26			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	17	0		29	10	S7694_017_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											590.78	25						590.78	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	18	0		29	10	S7694_018_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	18	0		29	10	S7694_018_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	18	0		29	10	S7694_018_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											32.94	20	20	20				22.89	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	18	0		29	10	S7694_018_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											60.97	40	40	40				45.34	35	35	35										40	40	40				35	35	35			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	18	0		29	10	S7694_018_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											606.72	25						606.72	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	19	0		29	10	S7694_019_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	19	0		29	10	S7694_019_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	19	0		29	10	S7694_019_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											33.59	20	20	20				24.07	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	19	0		29	10	S7694_019_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											63.75	40	40	40				48.6	37	37	37										40	40	40				37	37	37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	19	0		29	10	S7694_019_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											617.24	25						617.24	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	20	0		29	10	S7694_020_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	20	0		29	10	S7694_020_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	20	0		29	10	S7694_020_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	20	0		29	10	S7694_020_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											54.68	39	39	39				43.27	32	32	32										39	39	39				32	32	32			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	20	0		29	10	S7694_020_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											563.47	25						563.47	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	21	0		29	10	S7694_021_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	21	0		29	10	S7694_021_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	21	0		29	10	S7694_021_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											34.11	20	20	20				24.57	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	21	0		29	10	S7694_021_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											60.33	38	38	38				51.28	35	35	35										38	38	38				35	35	35			38			38								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	21	0		29	10	S7694_021_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											561.56	25						561.56	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	22	0		29	10	S7694_022_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	22	0		29	10	S7694_022_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	22	0		29	10	S7694_022_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					42	84	126											47	94	117.5				42	84	105				47				47			1.52	1.35		1.52	1.35	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	22	0		29	10	S7694_022_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											61.2	46	46	46				55.9	38	38	38										46	46	46				38	38	38			46			46								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	22	0		29	10	S7694_022_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											647.4	25						647.4	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	23	0		29	10	S7694_023_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	23	0		29	10	S7694_023_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	23	0		29	10	S7694_023_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											31.74	20	20	20				24.19	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	23	0		29	10	S7694_023_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											63.74	40	40	40				51.27	36	36	36										40	40	40				36	36	36			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	23	0		29	10	S7694_023_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											622.07	25						622.07	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	24	0		29	10	S7694_024_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	24	0		29	10	S7694_024_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	24	0		29	10	S7694_024_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											33.73	20	20	20				23.65	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	24	0		29	10	S7694_024_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											61.44	40	40	40				49.03	36	36	36										40	40	40				36	36	36			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	24	0		29	10	S7694_024_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											583.19	25						583.19	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	25	0		29	10	S7694_025_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	25	0		29	10	S7694_025_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	25	0		29	10	S7694_025_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											33.72	20	20	20				24.82	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	25	0		29	10	S7694_025_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											53.79	33	33	33				41.67	30	30	30										33	33	33				30	30	30			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	25	0		29	10	S7694_025_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											595.9	25						595.9	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	26	0		29	10	S7694_026_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	26	0		29	10	S7694_026_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	26	0		29	10	S7694_026_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											38.39	20	20	20				26.99	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	26	0		29	10	S7694_026_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											55.38	33	33	33				39.34	27	27	27										33	33	33				27	27	27			33			33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	26	0		29	10	S7694_026_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											601.89	25						601.89	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	27	0		29	10	S7694_027_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	27	0		29	10	S7694_027_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	27	0		29	10	S7694_027_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											38.39	20	20	20				27.6	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	27	0		29	10	S7694_027_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											47.18	28	28	28				37.36	25	25	25										28	28	28				25	25	25			28			28								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	27	0		29	10	S7694_027_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											691.97	25						691.97	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	28	0		29	10	S7694_028_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	28	0		29	10	S7694_028_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	28	0		29	10	S7694_028_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											36.88	20	20	20				26.04	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	28	0		29	10	S7694_028_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											48.13	31	31	31				40.78	28	28	28										31	31	31				28	28	28			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	28	0		29	10	S7694_028_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											620.54	25						620.54	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	29	0		29	10	S7694_029_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	29	0		29	10	S7694_029_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	29	0		29	10	S7694_029_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											32.18	20	20	20				23.16	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	29	0		29	10	S7694_029_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											57.18	36	36	36				43.56	33	33	33										36	36	36				33	33	33			36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	29	0		29	10	S7694_029_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											560.98	25						560.98	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	30	0		29	10	S7694_030_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	30	0		29	10	S7694_030_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	30	0		29	10	S7694_030_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	30	0		29	10	S7694_030_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											52.9	40	40	40				42.23	33	33	33										40	40	40				33	33	33			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	30	0		29	10	S7694_030_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											706.72	25						706.72	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	31	0		29	10	S7694_031_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	31	0		29	10	S7694_031_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	31	0		29	10	S7694_031_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											35.06	20	20	20				25.04	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	31	0		29	10	S7694_031_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											47.02	31	31	31				36.86	26	26	26										31	31	31				26	26	26			31			31								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	31	0		29	10	S7694_031_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											605.43	25						605.43	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	32	0		29	10	S7694_032_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	32	0		29	10	S7694_032_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	32	0		29	10	S7694_032_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	32	0		29	10	S7694_032_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											57.66	40	40	40				50.01	33	33	33										40	40	40				33	33	33			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	32	0		29	10	S7694_032_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											588.98	25						588.98	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	33	0		29	10	S7694_033_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	33	0		29	10	S7694_033_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	33	0		29	10	S7694_033_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											35.58	20	20	20				26.34	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	33	0		29	10	S7694_033_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											65.24	39	39	39				51.77	36	36	36										39	39	39				36	36	36			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	33	0		29	10	S7694_033_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											659.73	25						659.73	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	34	0		29	10	S7694_034_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	34	0		29	10	S7694_034_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	34	0		29	10	S7694_034_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											37.37	20	20	20				26.68	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	34	0		29	10	S7694_034_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											48.05	29	29	29				38.1	26	26	26										29	29	29				26	26	26			29			29								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	34	0		29	10	S7694_034_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											599.07	25						599.07	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	70	0		29	10	S7694_070_0	3	Preferred Generic	3	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								19	38	57					1	2	3											19	38	57				1	2	0				19				19			0.61	0.03		0.61	0.03	0.61	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	70	0		29	10	S7694_070_0	3	Generic	3	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								20	40	60					7	14	21											20	40	60				7	14	7				20				20			0.65	0.23		0.65	0.23	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	70	0		29	10	S7694_070_0	3	Preferred Brand	3	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	70	0		29	10	S7694_070_0	3	Non-Preferred Drug	3	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											59.07	39	39	39				47.72	32	32	32										39	39	39				32	32	32			39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	70	0		29	10	S7694_070_0	3	Specialty Tier	3	11	1	1	5	1		10	1		10	1				31								31			31		31											641.62	25						641.62	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	105	0		29	10	S7694_105_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	105	0		29	10	S7694_105_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	105	0		29	10	S7694_105_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											32.23	20	20	20				24.2	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	105	0		29	10	S7694_105_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											55.45	40	40	40				46.44	37	37	37										40	40	40				37	37	37			40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	105	0		29	10	S7694_105_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											615.92	25						615.92	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	106	0		29	10	S7694_106_0	3	Preferred Generic	2	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	106	0		29	10	S7694_106_0	3	Generic	2	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	4.5				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	106	0		29	10	S7694_106_0	3	Preferred Brand	2	11	1	1	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											32.43	20	20	20				25.66	15	15	15										20	20	20				15	15	15			20			20								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	106	0		29	10	S7694_106_0	3	Non-Preferred Drug	2	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											59.67	43	43	43				49.19	40	40	40										43	43	43				40	40	40			43			43								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	106	0		29	10	S7694_106_0	3	Specialty Tier	2	11	1	1	5	1		10	1		10	1				31								31			31		31											650.97	25						650.97	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	121	0		29	10	S7694_121_0	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	121	0		29	10	S7694_121_0	3	Generic	4	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	3				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	121	0		29	10	S7694_121_0	3	Preferred Brand	4	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	121	0		29	10	S7694_121_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											49.77	42	42	42				37.68	35	35	35										42	42	42				35	35	35			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	121	0		29	10	S7694_121_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											522.68	25						522.68	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	122	0		29	10	S7694_122_0	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	122	0		29	10	S7694_122_0	3	Generic	4	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	3				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	122	0		29	10	S7694_122_0	3	Preferred Brand	4	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	122	0		29	10	S7694_122_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											49.9	42	42	42				37.98	35	35	35										42	42	42				35	35	35			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	122	0		29	10	S7694_122_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											519.79	25						519.79	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	123	0		29	10	S7694_123_0	3	Preferred Generic	4	1	1	2	1	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								15	30	45					1	2	3											15	30	45				1	2	0				15				15			0.48	0.03		0.48	0.03	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	123	0		29	10	S7694_123_0	3	Generic	4	1	1	2	2	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								18	36	54					3	6	9											18	36	54				3	6	3				18				18			0.58	0.1		0.58	0.1	0.58	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	123	0		29	10	S7694_123_0	3	Preferred Brand	4	11	1	2	3	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31								47	94	141					35	70	105											47	94	117.5				35	70	87.5				47				47			1.52	1.13		1.52	1.13	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	123	0		29	10	S7694_123_0	3	Non-Preferred Drug	4	11	1	1	4	1		111	1		111	1				31	62	90	1	2				31	62	90	31		31											50.39	42	42	42				37.87	35	35	35										42	42	42				35	35	35			42			42								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S7694	123	0		29	10	S7694_123_0	3	Specialty Tier	4	11	1	1	5	1		10	1		10	1				31								31			31		31											513.75	25						513.75	25												25						25					25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8067	1	0		29	10	S8067_001_0	1	Preferred Generic	3	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15	30	45					8	16	24											15	30	45				8	16	24					15			15			0.5	0.27		0.5	0.27	0.48	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S8067	1	0		29	10	S8067_001_0	1	Generic	3	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					12	24	36											20	40	60				12	24	36					20			20			0.67	0.4		0.67	0.4	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S8067	1	0		29	10	S8067_001_0	1	Preferred Brand	3	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47	94	141					40	80	120											47	94	141				40	80	120					47			47			1.57	1.33		1.57	1.33	1.52	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S8067	1	0		29	10	S8067_001_0	1	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											85.38	50	50	50				85.38	50	50	50										50	50	50				50	50	50				50		50								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S8067	1	0		29	10	S8067_001_0	1	Specialty Tier	3	11	1	1	5	1		10	10		10	1				30								30				10	31											1187.42	30						1187.42	30												30						30						30		30								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S8067	1	0		29	10	S8067_001_0	1	Select Care Drugs	3	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs"												
S8067	3	0		29	10	S8067_003_0	1	Preferred Generic	4	1	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10	20	30					3	6	9											10	20	30				3	6	9					10			10			0.33	0.1		0.33	0.1	0.32	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
S8067	3	0		29	10	S8067_003_0	1	Generic	4	1	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20	40	60					10	20	30											20	40	60				10	20	30					20			20			0.67	0.33		0.67	0.33	0.65	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
S8067	3	0		29	10	S8067_003_0	1	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								45	90	135					38	76	114											45	90	135				38	76	114					45			45			1.5	1.27		1.5	1.27	1.45	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
S8067	3	0		29	10	S8067_003_0	1	Non-Preferred Brand	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								95	190	285					88	176	264											95	190	285				88	176	264					95			95			3.17	2.93		3.17	2.93	3.06	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
S8067	3	0		29	10	S8067_003_0	1	Specialty Tier	4	11	1	1	5	1		10	10		10	1				30								30				10	31											740.93	33						740.93	33												33						33						33		33								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
S8067	3	0		29	10	S8067_003_0	1	Select Care Drugs	4	1	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7	14	21					0	0	0											7	14	21				0	0	0					7			7			0.23	0		0.23	0	0.23	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs"												
S8182	1	0		29	10	S8182_001_0	4	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								6	12	18					1	2	3					1	2	3																6				6			0.2	0.03	0.03			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	1	0		29	10	S8182_001_0	4	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					2	4	6					2	4	6																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	1	0		29	10	S8182_001_0	4	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								38	76	114					27	54	81					27	54	81																38				38			1.27	0.9	0.9			1.12	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	1	0		29	10	S8182_001_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											98.02	36	36	36				84.41	31	31	31				31	31	31															36			36								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	1	0		29	10	S8182_001_0	4	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	2	0		29	10	S8182_002_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	2	0		29	10	S8182_002_0	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S8182	2	0		29	10	S8182_002_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	2	0		29	10	S8182_002_0	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S8182	2	0		29	10	S8182_002_0	4	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											23.75	22	22	22				21.59	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	2	0		29	10	S8182_002_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											68.87	40	40	40				65.43	38	38	38				38	38	38															40			40								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	2	0		29	10	S8182_002_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	3	0		29	10	S8182_003_0	4	Preferred Generic	3	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								6	12	18					1	2	3					1	2	3																6				6			0.2	0.03	0.03			0.18	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	3	0		29	10	S8182_003_0	4	Generic	3	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								7	14	21					2	4	6					2	4	6																7				7			0.23	0.07	0.07			0.21	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	3	0		29	10	S8182_003_0	4	Preferred Brand	3	11	1	2	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								34	68	102					24	48	72					24	48	72																34				34			1.13	0.8	0.8			1	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	3	0		29	10	S8182_003_0	4	Non-Preferred Drug	3	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											93.37	37	37	37				80.75	32	32	32				32	32	32															37			37								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	3	0		29	10	S8182_003_0	4	Specialty Tier	3	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	4	0		29	10	S8182_004_0	4	Preferred Generic	4	1	1	2	1	1		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	4	0		29	10	S8182_004_0	4	Preferred Generic	4	1	1	2	1	3		111	1	111		1				30	60	90	1	2	30	60	90				30		34								9	18	27					1	2	3					1	2	3																9				9			0.3	0.03	0.03			0.26	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S8182	4	0		29	10	S8182_004_0	4	Generic	4	1	1	2	2	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	4	0		29	10	S8182_004_0	4	Generic	4	1	1	2	2	3		111	1	111		1				30	60	90	2	2	30	60	90				30		34								10	20	30					2	4	6					2	4	6																10				10			0.33	0.07	0.07			0.29	"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"										1		
S8182	4	0		29	10	S8182_004_0	4	Preferred Brand	4	11	1	1	3	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											22.94	22	22	22				20.86	20	20	20				20	20	20															22			22								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	4	0		29	10	S8182_004_0	4	Non-Preferred Drug	4	11	1	1	4	1		111	1	111		1				30	60	90	2	2	30	60	90				30		34											63.94	39	39	39				60.66	37	37	37				37	37	37															39			39								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
S8182	4	0		29	10	S8182_004_0	4	Specialty Tier	4	11	1	1	5	1		10	1	10		1				30					30						30		34												25							25						25																	25			25								"Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier"												
